Challenges faced in biomedical waste management by waste handlers amidst the COVID-19 pandemic in a tertiary care hospital: a qualitative study

Introduction : Coronavirus disease 2019 (COVID-19) saw an overhaul in the biomedical waste management (BMWM) practices. Waste handlers were at the brunt of these changes. If the challenges pertaining to BMWM at the ground level are better understood, more effective measures to overcome them can be formulated. Objectives: 1. To identify myths and concerns regarding BMWM in the context of COVID-19 pandemic. 2. To explore the challenges faced in BMWM amidst the COVID-19 pandemic. 3.To explore opportunities and future perspectives of BMWM. Method: In-depth interviews were conducted among 17 purposively selected Class IV health care workers during August to November 2021 in a tertiary care institute in Mumbai. Data was reported using thematic analysis. Results: Three major themes - challenges and concerns faced by BMW handlers, enablers/motivators, opportunities and future practices were generated from the transcripts. Various challenges faced by waste handlers were- difficulties in segregation and transport of BMW, exhaustion from PPE usage and fear of acquiring and spreading COVID-19 from work, stigma faced from public, and handling COVID-19 deaths. Support from family and colleagues, incentives and a positive change in public perception enabled them to work. Forming redressal committees, addressing job security concerns and timely provision of good quality equipment can improve hospital waste management measures in the future. Conclusion: It is of utmost importance to address challenges faced by waste handlers in BMWM. Onus should also be on periodic training in BMWM.

Dampening of Inflammatory Markers and Understanding COVID-19 Viral Disease Development: A Combinatorial Approach

One of the hallmarks of the global pandemic of coronavirus disease 2019 (COVID-19) is that it targets the immune system by producing inflammatory cytokines. COVID-19 has expedited investigations on numerous therapeutics to fight the disease-causing virus SARS-CoV-2, some without well-established safety or efficacy data. The severity of the disease depends on a number of factors, including genetic background and preexisting conditions. The difference in the genetic makeup makes everyone unique and the understanding of the COVID-19 cure arduous. To dampen these inflammatory markers and to understand the viral disease dynamics, accounting for genetic variability, a combinational three-way approach involving bioinformatics, nutrigenomics, and pharmacogenomics will give answers to many unanswered questions involving patient care. A futuristic approach to prevention and cure calls for continuous research with practice and training provision to the right group, accompanied with the awareness enhancing its utility. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.

Genomic Characterization of Respiratory Syncytial Virus during 2022-23 Outbreak, Washington, USA.

We sequenced 54 respiratory syncytial virus (RSV) genomes collected during 2021-22 and 2022-23 outbreaks in Washington, USA, to determine the origin of increased RSV cases. Detected RSV strains have been spreading for >10 years, suggesting a role for diminished population immunity from low RSV exposure during the COVID-19 pandemic.

Response to an Outbreak of COVID-19 Infection Among Undergraduate Medical Students in Mumbai, Maharashtra

Introduction: Coronavirus Disease-2019 (COVID-19) is an infectious disease. The most effective way to slow down the transmission is by social distancing and following all the preventive protocols. Aim: To describe the outbreak of COVID-19 in forty Undergraduate (UG) medical students of a medical college in Mumbai during September 2021 steps taken to control the spread as well as to break the chain of transmission of COVID-19 infection. Materials and Methods: The institutional contact tracing team contacted the positive case and identified contacts as soon as they were notified during September 2021 at Seth GSMC & KEMH, Mumbai, Maharashtra, India. A total of 40 students were isolated due to the contraction of COVID infection. History was taken by telephonic calls. Meetings were held among the institute and hostel authorities to prevent the spread. All the contacts of positive cases were separated in a quarantine facility. COVID appropriate behaviour (CAB) was implemented strictly and swab of symptomatic students was taken for Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Non-academic leisure activities were suspended temporarily. Academic lectures were shifted to an online platform. Results: This outbreak lasted over a period of 10 days, a total of 40 students were isolated and 89 students were quarantined. Most of the students who were infected were residing in the hostels, 27 (67.5%) and had come in contact with other positive students during the college's cultural fest. Majority of positive cases had received both doses of COVID vaccination. Mild symptoms were present in 87.5% students and rest were asymptomatic. Cases were detected from the same cluster of students and follow-up was done for the next two weeks. Conclusion: Strategies like scheduled testing for in-campus students, strict implementation of CAB and temporary withdrawal of activities which causes gathering helped effectively to control the spread.

De novo emergence of a remdesivir resistance mutation during treatment of persistent SARS-CoV-2 infection in an immunocompromised patient: a case report.

SARS-CoV-2 remdesivir resistance mutations have been generated in vitro but have not been reported in patients receiving treatment with the antiviral agent. We present a case of an immunocompromised patient with acquired B-cell deficiency who developed an indolent, protracted course of SARS-CoV-2 infection. Remdesivir therapy alleviated symptoms and produced a transient virologic response, but her course was complicated by recrudescence of high-grade viral shedding. Whole genome sequencing identified a mutation, E802D, in the nsp12 RNA-dependent RNA polymerase, which was not present in pre-treatment specimens. In vitro experiments demonstrated that the mutation conferred a ~6-fold increase in remdesivir IC50 but resulted in a fitness cost in the absence of remdesivir. Sustained clinical and virologic response was achieved after treatment with casirivimab-imdevimab. Although the fitness cost observed in vitro may limit the risk posed by E802D, this case illustrates the importance of monitoring for remdesivir resistance and the potential benefit of combinatorial therapies in immunocompromised patients with SARS-CoV-2 infection.

A compendium of evidence related to 'social distancing' measure in view of the spread of COVID-19 pandemic

With no definitive treatment in place to date for the COVID-19 pandemic, reliance on public health measures is of utmost importance. Social distancing requires maintaining a physical distance of at least one meter between people and reducing the number of times people come into close contact with each other. Modeling evidence from past influenza pandemics and current experiences with COVID-19 indicates the role of SD in delaying the spread of the virus by reducing the probability that uninfected person will come into physical contact with an infected person.

Breastfeeding and coronavirus disease 2019 (COVID-19) vaccination: position statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices

Justification: In India, till recently, breastfeeding women have been excluded from the coronavirus disease (COVID-19) vaccination program, rendering a significant population of the country, including frontline workers, ineligible to derive the benefits of the COVID-19 vaccine rollout.

Breastfeeding and Coronavirus Disease 2019 (COVID-19) Vaccination: Position Statement of the Indian Academy of Pediatrics/Advisory Committee on Vaccination and Immunization Practices

JUSTIFICATION: In India, till recently, breastfeeding women have been excluded from the coronavirus disease (COVID-19) vaccination program, rendering a significant population of the country, including frontline workers, ineligible to derive the benefits of the COVID-19 vaccine rollout. OBJECTIVE: The objective of this recommendation is production of an evidence-based document to guide the pediatricians to give advice to breastfeeding mothers regarding the safety of COVID-19 vaccines in lactating women. PROCESS: Formulation of key question was done under the chairmanship of president of the IAP. It was followed by review of literature regarding efficacy and safety of COVID-19 vaccines in breastfeeding women. The recommendations of other international and national professional bodies were also deliberated in detail. The available data was discussed in the ACVIP focused WhatsApp group. Opinion of all members was taken and the final document was prepared after achieving consensus. RECOMMENDATIONS: The IAP/ACVIP recommends the administration of COVID-19 vaccines to all breastfeeding women. The IAP/ACVIP endorses the recent recommendation of the Government of India, to consider all breastfeeding women as eligible for COVID-19 vaccination.

Renal dysfunction, COVID-19 infection, and mortality

Background: Critically ill patients with the SARS-CoV-2 virus (COVID-19) infection have diverse clinical manifestations including renal dysfunction which can determine their short-term outcomes. We assess if renal dysfunction on day one of hospital admission is associated with increased mortality risk of patients with severe COVID-19 infection. Methods: We conducted a retrospective review of records of patients with severe COVID-19 infection admitted to the Intensive Care Unit between March 4 and April 11, 2020. Patients were divided into two groups based on serum creatinine level on day one of hospital admission. Group 1 included patients with normal serum creatinine (SCr) 1.10 mg/dl while group 2 included patients with high SCr > 1.10 mg/dl. The primary outcome was mortality. Secondary outcomes were the need for renal replacement therapy (RRT), duration of RRT, development of adult respiratory distress syndrome (ARDS) and need for mechanical ventilation. Comparisons between groups were done using Mann-Whitney U-tests for continuous variables and chi-square tests for categorical variables. Mortality was evaluated with a Kaplan-Meier Survival Analysis. Results: A total of 47 patients were included: 27 in group 1 and 20 in group 2. Patients in group 2 compared to group 1 were older (67 vs. 56, p=0.04), more frequently African Americans (11% vs 45%, p=0.02), hypertensives (80% vs 52%, p=0.05) with chronic kidney disease (25% vs 0%, p=0.01), without significant differences sex, diabetes mellitus, smoking status or use of renin-angiotensin antagonists. 8 patients in group 2 and 3 patients in group 1 died, with significant difference in cumulative survival (Figure 1). Need for RRT (55% vs 41%, p=0.33), duration of RRT (6 vs 3 days, p=0.08), development of ARDS (85% vs 81%, p=0.75) and need for mechanical ventilation (65% vs 61%, p=0.89) were not significantly different between groups 2 and 1. Conclusions: The presence of renal dysfunction on the day of hospital admission is associated with increased hospital mortality in patients with severe COVID-19 infection.