Deaths and COVID-19: Talk, silence and alternative realities

This article critically considers the UK Government's insidious attempts to control the narrative around COVID-19 deaths through using the interrelated strategies of "talk and 'silence' in order to socially construct a definitive 'truth'" around the virus. The article traces how these strategies worked in practice and the shift which took place from numerous press briefings and Parliamentary debates to an ominous silence around the number of deaths, in particular. At the same time, as the article illustrates, the government's truth has not prevailed. Their twin strategy has been contested and resisted by grassroots organizations and radical lawyers who have demanded that Ministers should take responsibility for the tens of thousands of preventable deaths which have occurred. Rather than government talk and silence prevailing, it is the voices of the haunted relatives of the dead, demanding accountability, which are creating an alternative narrative.

Death, trauma and grief: the case of the prison

This paper critically analyses deaths in prison in England and Wales. It focuses on how the state's ‘truth' about the nature and extent of these deaths has been challenged and develops an alternative perspective which situates these deaths in the context of a system built on violence and systemic indifference and where state agents are protected by a culture of immunity and impunity. It also illustrates the often-abysmal treatment of the families of dead prisoners and the struggles they have engaged in, alongside the charity INQUEST1, to establish the actual truth about the deaths of their relatives and to hold to account those responsible for these deaths, many of which were preventable. The paper concludes by outlining a range of radical alternatives to the current baleful situation including humanising prisoners and removing the stigma of less eligibility which has prevailed for 200 years and has legitimated the pain and punishment inflicted on them by the state. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

High severity and mortality of non-COVID-19 critically ill patients during the COVID-19 pandemic

Background: The transmission and the fatality rates of coronavirus disease 2019 (COVID-19) are high enough to cause the strain of intensive care resources, and even influence the treatment and prognosis of non-COVID-19 patients. Therefore, the collateral damages to non-COVID-19 critically ill patients before and during the COVID-19 pandemic were evaluated. Method(s): Demographic data, severity, clinical course, and prognosis of non-COVID-19 patients admitted to the intensive care unit (ICU) via the emergency room (ER) before and during the COVID-19 pandemic were acquired from electronic medical records from three university-affiliated tertiary hospitals. Result(s): A total of 619 patients before and 542 patients during the pandemic were enrolled. During the COVID-19 pandemic, simplified acute physiology score (SAPS) 3 and the sequential organ failure assessment score (SOFA) on ER admission (SAPS3 72.7 +/- 20.3 versus 65.9 +/- 18.6, p <0.001, respectively;SOFA score 8.1 +/- 4.2, versus 7.2 +/-4.2, p <0.001, respectively) were significantly higher than those before the pandemic. The length of stay in the ER, ICU, and hospital was longer (p<0.05 in all). Finally, the hospital mortality rate was significantly higher during the pandemic than those before (39.7% versus 28.4%, p<0.001). The overall survival in the Kaplan-Meier curve analysis with log-rank test was significantly higher during the pandemic (p=0.04). Conclusion(s): These result of increased severity, hospital day and mortality in non-COVID-19 patients indicate the collateral damage to non-COVID-19 patients due to shortages in medical resources for them. Strategic management of medical resources is required to halt these consequences.

Investigating Disparities in Telehealth Among CKD Patients in a US Integrated Healthcare System

Background: Telehealth utilization, including the use of telephone appointments (TAV) and video appointment visits (VAV), are a valuable alternative to in-person visits and were a crucial form of health delivery during the COVID-19 national emergency. Among chronic kidney disease (CKD) patients within an integrated healthcare system, we evaluated the rate of successfully completed telehealth visits and assess differences in adoption using an equity lens. Method(s): A retrospective cohort study was conducted among individuals (age>=18yrs) with CKD stage 3 and 4 receiving care at Kaiser Permanente Southern California (KPSC). We limited our sample to patients with at least one in-person visit within 12 months prior to Mar 1, 2020 and followed them for 1 year. A successfully completed telehealth visit was defined as a >=20 min completed appointment via TAV/VAV. Poisson regression with robust variance error was conducted to estimate the rate ratio for a successful telehealth visit. Result(s): Of 161,088 patients, 74% (N=118,456) had >= 1 successfully completed telehealth visit, 34% of which were VAVs. Younger age, female gender, white race, and English as spoken language were associated with the successful completion of a telehealth visit. Senior persons (85+) were less likely to have a successfully TAV/VAV compared to young adults (18-34 yrs) (RR:0.82;95% CI:0.79-0.86) (Figure). Those having a KPSC online account were more likely to have successful TAV/VAV (RR:1.11;95% CI:1.10-1.12). Medicaid patients had more successful telehealth visits while patients living in neighborhoods with less internet access were marginally less likely to have successful TAV/VAV (p=0.05). Conclusion(s): We observed disparities in adoption of telehealth care among CKD patients within an integrated health system. Our findings suggest that further studies and management strategies are needed to facilitate and improve equitable patient-centered care.

Recording and timing vocal responses in online experimentation

Cued shadowing is a psycholinguistic task that captures the response speed and accuracy of participants' vocal repetition of target words. Due to its simplicity, the paradigm is widely used as a naturalistic measure of speech processing. While the COVID-19 pandemic has driven the adaptation of many lab-based experiments to internet-based data collection, cued shadowing is not straightforward to adapt due to various challenges, including the precision of timing, efficient extraction of response latencies, and control over data quality. The current paper presents solutions to these challenges and describes the methodology for conducting cued shadowing of audio-video stimuli online with children and adults. The performance of two (semi-)automatic speech onset detection tools and two experimental designs are evaluated. The technique developed enables millisecond precision in response time measurement and has great potential for the inclusion of minority and hard-to-reach communities in future speech perception and production research. Copyright © 2022 ISCA.

OUTCOMES OF HOSPITALIZED PATIENTS WITH COVID-19 AND ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY

The incidence of acute kidney injury (AKI) in COVID-19 patients has been reported as high as 47%, with mortality ranging from 3580% in this population. AKI patients requiring renal replacement therapy (RRT) likely have a greater mortality risk. Our aim was to describe outcomes of AKI patients who required RRT among hospitalized COVID-19 patients from a large diverse population in Southern California. We conducted a retrospective cohort study of COVID-19 patients with AKI requiring RRT defined as conventional hemodialysis, continuous renal replacement therapy, or both, within Kaiser Permanente Southern California in the period of 3/14/2020 through 9/30/2020. We collected information on patient characteristics, comorbidities, laboratory values, RRT modality, mortality, and post hospitalization RRT requirements. A total of 167 COVID-19 patients, median age 62 years (range 2592), had AKI requiring RRT. Overall, 114 (68%) patients died during the hospitalization, with a median of 8 days on RRT (range 1-83). Fifty-six (49.1%) patients expired within 7 days of initiating RRT, 87 (76.3%) within 14 days, and 106 (93.0%) within 30 days. Highest mortality rates were observed among AKI RRT patients with baseline eGFR >60 (75.2%), compared to 64% and 39% among patients with eGFR 30-59 and <30 ml/min respectively. Among patients who survived and no longer required dialysis, the mean number of inpatient RRT days was 21 (SD 16). Upon discharge from the hospital 29/53 (54.7%) patients continued to require RRT on an outpatient basis. Among COVID-19 patients hospitalized with AKI requiring RRT, patient survival was low (32%). For patients who survived, more than half continued to be dialysis dependent. Given our findings and as COVID treatment continues to evolve, we hope to elucidate additional factors that may impact AKI and survival in COVID-19 patients.

3D-DOSS - Using Digital Twins and Spatiotemporal Data Mapping for Infectious Disease Surveillance and Outbreak Investigations

Background. The COVID-19 pandemic has brought to light the importance of contact tracing in outbreak management. Digital technologies have been leveraged to enhance contact tracing in community settings. However, within complex hospital environments, where patient and staff movement and interpersonal interactions are central to care delivery, tools for contact tracing and cluster detection remain limited. We aimed to develop a system to promptly, identify contacts in infectious disease exposures and detect infectious disease clusters. Methods. We prototyped a 3D mapping tool 3-Dimensional Disease Outbreak Surveillance System (3D-DOSS), to have a spatial representation of patients in the hospital inpatient locations. Based on the AutoCAD drawings, the hospital physical spaces are built within a game-development software to obtain accurate digital replicas. This concept borrows from the way gamers interact with the virtual world/space, to mimic the interactions in physical space, like the SIMS franchise. Clinical, laboratory and patient movement data is then integrated into the virtual map to develop syndromic and disease surveillance systems. Risk assignment to individuals exposed is through mathematical modeling based on distance coordinates, room type and ventilation parameters and whether the disease is transmitted via contact, droplet or airborne route. Results. We have mapped acute respiratory illness (ARI) data for the period September to December 2018. We identified an influenza cluster of 10 patients in November 2018. In a COVID-19 exposure involving a healthcare worker (HCW), we identified 44 primary and 162 secondary contacts who were then managed as per our standard exposure management protocols. MDRO outbreaks could also be mapped. Conclusion. Through early identification of at-risk contacts and detection of infectious disease clusters, the system can potentially facilitate interventions to prevent onward transmission. The system can also support security, environmental cleaning, bed assignment and other operational processes. Simulations of novel diseases outbreaks can enhance preparedness planning as health systems that had been better prepared have been more resilient in this current pandemic.

Frontiers: Virus Shook the Streaming Star: Estimating the COVID-19 Impact on Music Consumption

Many have speculated that the recent outbreak of COVID-19 has led to a surge in the use of online streaming services. However, this assumption has not been closely examined for music streaming services, the consumption patterns of which can be different from video streaming services. To provide insights into this question, we analyze Spotify's streaming data for the weekly top 200 songs for two years in 60 countries between June 2018 and May 2020, along with varying lockdown policies and detailed daily mobility information from Google. Empirical evidence shows that the COVID-19 outbreak significantly reduced music streaming consumption in many countries. We also find that countries with larger mobility decreases saw more notable downturns in streaming during the pandemic. Further, we reveal that the mobility effect was attributable to the complementarity of music consumption to other activities and likely to be transient rather than irreversible. Alternative mechanisms, such as unobservable Spotify-specific factors, a demand shift from top-selling songs to niche music, and supply-side effects, did not explain the decline in music consumption.

Comparison of safety and outcomes related to remdesivir use among dialysis patients hospitalized with COVID-19

Background: Use of remdesivir in the treatment of dialysis patients with Coronavirus Disease 2019 (COVID-19) has been limited due to inconclusive data regarding safety outcomes among patients with severe renal impairment. For this reason, the FDA has not recommended remdesivir use in patients with eGFR < 30 ml/min per 1.73 m2. We sought to evaluate outcomes among dialysis patients with COVID-19 who received remdesivir in a real-world setting. Methods: We conducted a retrospective study of patients on hemodialysis or peritoneal dialysis hospitalized with COVID-19 between 5/1/2020 -1/31/2021 within the integrated health system of Kaiser Permanente Southern California. Patients with a COVID-19 International Classification of Diseases (ICD)-10 code: U07.1 and laboratory confirmed SARS-CoV-2 infection within 14 days prior to admission date to two days after admission date were included. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were intensive care unit (ICU) stay, and evidence of acute liver injury defined as AST and/or ALT values >5x upper limit of normal. Results: A total of 486 patients (407 hemodialysis and 79 peritoneal dialysis) met inclusion criteria. Among those, 112 patients (23%) were treated with remdesivir, with median treatment time of 4 days (IQR: 2-5). Mean age was 63.8 years with 63.8% male and 63.0% Hispanic patients. There were 80.2% of patients who received treatment with steroids during hospitalization. Relative risk (RR) for all-cause 30-day mortality was 0.74 (95% CI: 0.52-1.05) in remdesivir treated patients compared to untreated patients. Acute liver injury occurred in 1.8% and 2.4% of remdesivir treated and untreated patients, respectively. ICU admissions occurred in 14.3% of remdesivir treated and 16% of untreated patients. Conclusions: Among dialysis patients hospitalized with COVID-19, treatment with remdesivir was not associated with worse outcomes in terms of liver injury or ICU admission, and demonstrated a trend (26% lower risk) toward decrease in 30-day mortality, though no statistical significance was found due to insufficient power.

COVID-19 vaccination acceptability in the UK at the start of the vaccination programme: a nationally representative cross-sectional survey (CoVAccS - wave 2).

OBJECTIVES: Investigate factors associated with the intention to have the COVID-19 vaccination following initiation of the UK national vaccination programme. STUDY DESIGN: An online cross-sectional survey completed by 1500 adults (13th-15th January 2021). METHODS: Linear regression analyses were used to investigate associations between intention to be vaccinated for COVID-19 and sociodemographic factors, previous influenza vaccination, attitudes and beliefs about COVID-19 and COVID-19 vaccination and vaccination in general. Participants' main reasons for likely vaccination (non-)uptake were also solicited. RESULTS: 73.5% of participants (95% CI 71.2%, 75.7%) reported being likely to be vaccinated against COVID-19, 17.3% (95% CI 15.4%, 19.3%) were unsure, and 9.3% (95% CI 7.9%, 10.8%) reported being unlikely to be vaccinated. The full regression model explained 69.8% of the variance in intention. Intention was associated with: having been/intending to be vaccinated for influenza last winter/this winter; stronger beliefs about social acceptability of a COVID-19 vaccine; the perceived need for vaccination; adequacy of information about the vaccine; and weaker beliefs that the vaccine is unsafe. Beliefs that only those at serious risk of illness should be vaccinated and that the vaccines are just a means for manufacturers to make money were negatively associated with vaccination intention. CONCLUSIONS: Most participants reported being likely to get the COVID-19 vaccination. COVID-19 vaccination attitudes and beliefs are a crucial factor underpinning vaccine intention. Continued engagement with the public with a focus on the importance and safety of vaccination is recommended.