Protective efficacy of a SARS-CoV-2 DNA vaccine in wild type and immunosuppressed Syrian hamsters

A worldwide effort to counter the COVID-19 pandemic has resulted in hundreds of candidate vaccines moving through various stages of research and development, including several vaccines in phase 1, 2 and 3 clinical trials. A relatively small number of these vaccines have been evaluated in SARS-CoV-2 disease models, and fewer in a severe disease model. Here, a SARS-CoV-2 DNA targeting the spike protein and delivered by jet injection, nCoV-S(JET), elicited neutralizing antibodies in hamsters and was protective in both wild-type and transiently immunosuppressed hamster models. This study highlights the DNA vaccine, nCoV-S(JET), we developed has a great potential to move to next stage of preclinical studies, and it also demonstrates that the transiently immunosuppressed Syrian hamsters, which recapitulate severe and prolonged COVID-19 disease, can be used for preclinical evaluation of the protective efficacy of spike-based COVID-19 vaccines.

Predictors of Respiratory Bacterial Co-Infection in Hospitalized COVID-19 Patients

Background. COVID-19 pneumonia can be indistinguishable from other infectious respiratory etiologies, so providers are challenged with deciding whether empiric antibiotics should be prescribed to hospitalized patients with SARS-CoV-2. This study aimed to evaluate predictors of respiratory bacterial co-infections (RBCI) in hospitalized patients with COVID-19. Methods. Retrospective study evaluating COVID-19 inpatients from Feb 1, 2020 to Sept 30, 2020 at a tertiary academic medical center. Patients with RBCI were matched with three COVID-19 inpatients lacking RBCI admitted within 7 days of each other. The primary objectives of this study were to determine the prevalence of and identify variables associated with RBCI in COVID-19 inpatients. Secondary outcomes included length of stay and mortality. Data collected included demographics;inflammatory markers;bacterial culture/antigen results;antibiotic exposure;and COVID-19 severity. Wilcoxon rank sum, Chi Square tests, or Fisher's exact tests were utilized as appropriate. A multivariable logistic regression (MLR) model was conducted to identify covariates associated with RBCI. Results. Seven hundred thirty-five patients were hospitalized with COVID-19 during the study period. Of these, 82 (11.2%) had RBCI. Fifty-seven of these patients met inclusion criteria and were matched to three patients lacking RBCI (N = 228 patients). Patients with RBCI were more likely to receive antibiotics [57 (100%) vs. 130 (76%), p < 0.0001] and for a longer cumulative duration [19 (13-33) vs. 8 (4-13) days, p < 0.0001] compared to patients lacking RBCI. The MLR model revealed risk factors of RBCI to be admission from SNF/LTAC/NH (AOR 6.8, 95% CI 2.6-18.2), severe COVID-19 (AOR 3.03, 95% CI 0.78-11.9), and leukocytosis (AOR 3.03, 95% CI 0.99-1.16). Conclusion. Although RBCI is rare in COVID-19 inpatients, antibiotic use is common. COVID-19 inpatients may be more likely to have RBCI if they are admitted from a SNF/LTAC/NH, have severe COVID-19, or present with leukocytosis. Early and prompt recognition of RBCI predictors in COVID-19 inpatients may facilitate timely antimicrobial therapy while improving antimicrobial stewardship among patients at low risk for co-infection.

OPTN/SRTR 2020 Annual Data Report: Lung.

For the first time in a decade, both the number of candidates added to the waiting list and the number of lung transplants performed decreased from the year prior; the number of lung donors also declined. This slowing of transplant activities in 2020 was associated with a modest increase in waitlist mortality. The year 2020 was notable for the global outbreak of the COVID-19 pandemic, which undoubtedly influenced all trends noted in lung transplantation. Time to transplant continued to decrease, with a median time to transplant of 1.4 months across all waitlist candidates. Posttransplant survival remained stable, with 89.4% of transplant recipients surviving to 1 year, 74.8% to 3 years, and 61.2% to 5 years.

OPTN/SRTR 2020 Annual Data Report: Kidney.

The year 2020 presented significant challenges to the field of kidney transplantation. After increasing each year since 2015 and reaching the highest annual count to date in 2019, the total number of kidney trans- plants decreased slightly, to 23642, in 2020. The decrease in total kidney transplants was due to a decrease in living donor transplants; the number of deceased donor transplants rose in 2020. The number of patients waiting for a kidney transplant in the United States declined slightly in 2020, driven by a slight drop in the number of new candidates added in 2020 and an increase in patients removed from the waiting list owing to death-important patterns that correlated with the COVID-19 pandemic. The complexities of the pandemic were accompanied by other ongoing challenges. Nationwide, only about a quarter of waitlisted patients receive a deceased donor kidney transplant within 5 years, a proportion that varies dramatically by donation service area, from 14.8% to 73.0%. The nonutilization (discard) rate of recovered organs rose to its highest value, at 21.3%, despite a dramatic decline in the discard of organs from hepatitis C-positive donors. Nonutilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. Due to pandemic-related disruption of living donation in spring 2020, the number of living donor transplants in 2020 declined below annual counts over the last decade. In this context, only a small proportion of the waiting list receives living donor transplants each year, and racial disparities in living donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft exceeded 250,000 in 2020. Pediatric transplant numbers seem to have been impacted by the COVID-19 pandemic. The total number of pediatric kidney transplants performed decreased to 715 in 2020, from a peak of 872 in 2009. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients, with continued racial disparities among recipients. Of concern, the rate of deceased donor transplant among pediatric waitlisted candidates continued to decrease, reaching its lowest point in 2020. While this may be partly explained by the COVID-19 pandemic, close attention to this trend is critically important. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease in the pediatric population. While most pediatric de- ceased donor recipients receive a kidney from a donor with KDPI less than 35%, most pediatric deceased donor recipients had four or more HLA mis- matches. Graft survival continues to improve, with superior survival for living donor recipients versus deceased donor recipients.

OPTN/SRTR 2020 Annual Data Report: Liver.

This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased. On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020. Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men.

OPTN/SRTR 2020 Annual Data Report: Heart.

As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; however, the number of adult heart transplants performed continued to increase, to 3715 in 2020. The number of pediatric heart transplants declined from 509 in 2019 to 465 in 2020. One-year and six-month posttransplant mortality rates in adult recipients have increased slightly since 2015 but have not significantly changed over the past decade. Overall, posttransplant mortality rates for adult recipients were 7.4% at six months and 9.4% at one year for transplants in 2019, 14.0% at three years for transplants in 2017, and 19.1% at five years for transplants in 2015. Although shorter-term posttransplant mortality rates have slightly increased, there has been a steady downward trend in longer-term mortality. Mortality rates for pediatric recipients were 5.7% at six months and 8.1% at one year for transplants in 2019, 11.6% at three years for transplants in 2017, and 15.2% at five years for transplants in 2015.

Making the Most of Virtual Community Engagement for International Projects During the COVID-19 Pandemic

The Responsible Mining, Resilient Communities project is a multi-country, interinstitutional, and interdisciplinary global research collaboration whose goal is to co-design socially responsible and sustainable gold mining practices with communities, engineers, and social scientists. A key component of this work is engineering education research that investigates how situated learning enhances undergraduate students' global sociotechnical competency, especially as it relates to their ability to define and solve problems with people from diverse disciplinary backgrounds and life experiences. Situated learning refers to how students learn under different a) configurations of social relations (e.g., graduate/undergraduate;expert/non-expert;US/non-US students, etc.);b) pedagogical strategies for engineering problem definition and solution (e.g., remote vs. in-person;in-class vs. in-field);and c) different geographical contexts (e.g., in the US vs. in Colombia) affect faculty and student learning. Global sociotechnical competency refers to having the knowledge, skills, and attitudes to define and solve engineering problems as socio-technical in different international settings. Knowledge is understanding how engineering problems are always socio-technical and shaped by the historical, cultural, economic, and physical dimensions of a place. Skills are learning to define and solve problems with perspectives different than their own. Attitudes are the desires to continue engaging other expert and non-expert perspectives, working abroad, and serving communities after graduation. In 2019 a diverse group of engineering undergraduate students from the Colorado School of Mines, United States Air Force Academy, and Universidad Nacional de Colombia - Medellín participated in a two-week field session in Colombia, where they visited mine sites and processing facilities, in addition to the partner university in Colombia. In 2020, however, the burgeoning COVID-19 pandemic made international fieldwork impossible. This paper will describe how we developed and executed a meaningful distance-based fieldwork experience that maintained direct engagement with international students and community members. We will offer a preliminary assessment of these methods' efficacy for developing global sociotechnical competency through remote community engagement and learning. We will analyze the situated learning of the student participants as they differently identified stakeholders for engineering projects and changed their understanding of mining as a sociotechnical process as a result of the summer session. As a part of this analysis, we will also compare 2019 (in the field) and the 2020 (virtual) learning outcomes for the two different sets of students. © American Society for Engineering Education, 2021

[Adaptation of psychiatric practice in public and private mental health institutions of the City of Buenos Aires during the COVID-19 pandemic]

BACKGROUND: One of the most significant indirect impacts of the COVID-19 pandemic will be seen on the mental health of the population. On this study, we will take into account the adapting capacity that the most representative mental health services (MHS) of Buenos Aires (BA) City have had as to this new situation. METHODS: We designed an online survey including 10 self-administered closed questions, strictly anonymous. It has been sent to targeted professionals who work in public and private MHS of BA after 2 months of the beginning of the lockdown. RESULTS: We got 38 answers. 2 professionals rejected to answer. 34% belonged to private institutions and 66% to public ones. 81% of the total were able to implement online assistance but only 24% had been trained on how to treat patients in this context. 69% of the private and 12% of the public sector professionals informed to have been trained on telemedicine tools. 69% of the private and 36% of the public sector professionals informed to have prepared materials for the users on telemedicine resources. 68% mentioned that their service was properly organized. 40% of the public sector professionals may have been reassigned to work on tasks related to the pandemic. 40% of the total informed a reduced capacity of assistance. CONCLUSIONS: The MHS of BA may have been able to migrate their assistance to telemedicine, however we have noticed differences in the training levels. A better capacity of training on this modality might be needed.

Incidence of COVID-19 disease in pediatric kidney transplant recipients: A report of the improving renal outcomes collaborative

Background: The impact of COVID-19 disease on previously healthy children has been minimal, yet there is limited data on the impact of COVID-19 on children and adolescents with kidney transplants. Methods: We used the existing infrastructure of the Improving Renal Outcomes Collaborative (IROC) learning health system to develop and rapidly implement a webbased registry for collecting clinical and outcomes data about COVID-19 disease in pediatric transplant recipients. We distributed the registry to 32 U.S. pediatric kidney transplant centers and requested clinical and outcomes data from all recipients suspected of having COVID-19 disease. Here, we present an interim analysis of the first 6 weeks of registry data. Results: Between April 6 and May 27, 2020, 18 IROC centers entered data on 99 pediatric kidney transplant recipients who had PCR based testing for COVID-19. 54 patients were tested due to symptoms of COVID-19 (most commonly fever and cough), 7 asymptomatic patients had a known COVID exposure. 34 patients were tested per hospital policy (e.g. pre-anesthesia), and 4 did not have a reported testing indication. Overall, 10/99 (10%) tested positive for COVID-19, 6 of whom had any symptoms, 3 had a known exposure with a COVID+ individual, and 1 was diagosed by a pre-anesthesia screen. Thus far, the clinical course and outcomes are known in 8/10 COVID-19+ patients: 5 received outpatient supportive care alone, 2 were admitted to intensive care and 1 was admitted to a non-intensive care inpatient unit. Transplant outcomes were excellent in all COVID-19+ patients. There were no cases with respiratory failure, acute kidney injury, or allograft rejection/failure. There were no deaths due to COVID-19 disease. Conclusions: In this interim analysis of the IROC learning health system, pediatric kidney transplant recipients had a relatively low incidence of COVID-19 disease and excellent short-term outcomes.

COVID-19 and Post-intensive Care Syndrome: Community-Based Care for ICU Survivors

Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors. © The Author(s) 2020.