Using Grand Rounds to Train and Prepare a Local Public Health Workforce To Manage COVID-19 Outbreaks During the 2020-2021 Pandemic Winter Upsurge.

In response to the coronavirus disease 2019 (COVID-19) pandemic, the Los Angeles County Department of Public Health (DPH) expanded its workforce by >250 staff during Fall 2020 to manage the expected volume of outbreaks, which ultimately peaked. The workforce included reorganized groups of physicians, nurses, outbreak investigators from several DPH programs, and a 100+ member data science team tasked with designing and operating a data system and information flow process that became the backbone infrastructure of support for field investigation and outbreak management in real-time. The accelerated workforce expansion was completed in 3 months. To prepare new and reassigned permanent staff for fieldwork, DPH and several faculty from the Emory University Rollins School of Public Health adopted a flexible, skills-based series of medical Grand Rounds. These 16 sessions were grounded in practice- and problem-based learning principles using case studies, interactive scenarios, and didactic presentations based on scientific and public health practice information to teach knowledge and skills that were needed to manage COVID-19 outbreaks in different sectors. The evaluation suggests positive experience with the training series as well as impact on job performance.

Protecting First Responders While Maintaining Personal Privacy During the COVID-19 Pandemic: One County's Approach.

In this case study, the authors discuss a special situation infectious disease alert process for first responders. Issues explored include the development of this infectious disease alert process and legal issues that the DuPage County Health Department addressed to share protected health information between public health and public safety. The authors illustrate the important relationship between a local health department and its legal counsel as they balanced the needs of different stakeholder groups and identified a solution that satisfied both without infringing on individual privacy. The case study closes with a discussion regarding the value of multisector collaborations and opportunities to improve information sharing between sectors.

An Organizational Assessment of 34 Home Delivered Meals Programs that Engaged and Assisted Homebound Individuals With Obtaining the COVID-19 Vaccine During the Pandemic.

Vaccinating homebound individuals during the COVID-19 pandemic presented several challenges, including time and cost of engaging this group. In Los Angeles County, the departments of Public Health and Aging and Disabilities turned to home delivered meals programs (HDMs) for help with this public health priority. A mixed-method organizational assessment of 34 HDMs was conducted during March-April 2022 to describe these efforts. Most HDMs were nonprofit (67.6%) and had <25 staff (58.8%). Overall, they served a large catchment area before and during COVID-19, providing services to an estimated total of 24,995 clients/week and delivering 19,511 meals/day. A majority (82.4%) reported engaging their clients to facilitate COVID-19 vaccinations. As of early 2022, <6% of these HDMs' homebound clients were unvaccinated. These programs' efforts to assist older individuals who were homebound during the pandemic represent a potentially underutilized model of public-nonprofit/not-for-profit partnership for improving vaccine delivery and uptake in this hard-to-reach population.

Allogeneic haemopoietic cell transplant services in Australia and New Zealand in the first year of the COVID-19 pandemic: a report from Australia and New Zealand transplant and cellular therapies.

BACKGROUND: The COVID-19 pandemic has caused major disruption to health systems, with allogeneic haemopoietic cell transplant (alloHCT) services a particularly vulnerable area. Ongoing provision of alloHCT has required dynamic responses at national and local levels. In Australia and New Zealand (ANZ), a high reliance on unrelated donors from overseas registries has posed an additional challenge. AIMS: To describe the impact of COVID-19 on alloHCT services in ANZ in the first year of the pandemic. METHODS: Data from the national alloHCT patient and unrelated donor registries were extracted for a 2-year time frame. Comparisons were made between a pre-pandemic period of 1 March 2019 to 29 February 2020 and the corresponding dates during the pandemic, 1 March 2020 to 28 February 2021. RESULTS: There was a 13% decrease in the number of allogeneic transplants, a reversal of steady increases in previous years, with the largest decrease in unrelated donor transplants. Local donors supplied a greater proportion of unrelated stem cell products. With a switch to universal cryopreservation, the time from request of a product to infusion increased by a median of 25.5 days for overseas products and 14 days for local products. There was a significant increase in the number of products collected but not used. CONCLUSIONS: A strong public health response and coordinated transplant community activities allowed for safe provision of alloHCT in ANZ; however, our data suggest that the timely delivery of allogeneic transplants was affected by the COVID-19 pandemic. Continued dedicated efforts are required to minimise further impacts.

Factors associated with delaying medical care: cross-sectional study of Nebraska adults.

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state. METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals. RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [< 45 years aOR 6.17 (3.24-11.76); 45-64 years aOR 2.36 (1.29-4.32)], low- and middle-income [< $50,000 aOR 2.85 (1.32-6.11); $50,000-$74,999 aOR 3.06 (1.50-6.23)], and no health insurance [aOR 3.56 (1.21-10.49)]. Transportation delays were associated with being non-White [aOR 8.07 (1.54-42.20)], no bachelor's degree [≤ high school aOR 3.06 (1.02-9.18); some college aOR 4.16 (1.32-13.12)], and income < $50,000 [aOR 8.44 (2.18-32.63)]. Those who did not have a primary care provider were 80% less likely to have transportation delays [aOR 0.20 (0.05-0.80)]. CONCLUSIONS: Delayed care affects more than one-third of Nebraskans, primarily due to financial concerns, and impacting low- and middle-income families. Transportation-related delays are associated with more indicators of low socio-economic status. Policies targeting minorities and those with low- and middle-income, such as Medicaid expansion, would contribute to addressing disparities resulting from delayed care.

A Repeat Pattern of Founder Events for SARS-CoV-2 Variants in Alaska.

Alaska is a unique US state because of its large size, geographically disparate population density, and physical distance from the contiguous United States. Here, we describe a pattern of SARS-CoV-2 variant emergence across Alaska reflective of these differences. Using genomic data, we found that in Alaska, the Omicron sublineage BA.2.3 overtook BA.1.1 by the week of 27 February 2022, reaching 48.5% of sequenced cases. On the contrary, in the contiguous United States, BA.1.1 dominated cases for longer, eventually being displaced by BA.2 sublineages other than BA.2.3. BA.2.3 only reached a prevalence of 10.9% in the contiguous United States. Using phylogenetics, we found evidence of potential origins of the two major clades of BA.2.3 in Alaska and with logistic regression estimated how it emerged and spread throughout the state. The combined evidence is suggestive of founder events in Alaska and is reflective of how Alaska's unique dynamics influence the emergence of SARS-CoV-2 variants.

An organizational assessment of 101 Community-Based Adult Services centers to identify and address gaps in influenza vaccination among Medicare-Medicaid beneficiaries.

INTRODUCTION: Medicare-Medicaid beneficiaries are at high risk of experiencing severe disease from influenza. Yet, immunization assessment followed by influenza vaccination (when needed) are not regularly performed at Community-Based Adult Services (CBAS) centers in/near medically underserved areas. To better understand this challenge, an organizational assessment was conducted in early 2020 to identify and examine modifiable factors that may impede or facilitate immunization assessment and influenza vaccination at CBAS centers in Los Angeles County (LAC), California. METHODS: All 158 CBAS centers in LAC were asked to complete a 17-question survey. The survey asked about immunization assessment, gaps in communication with primary care providers, knowledge and use of the California Immunization Registry (CAIR), and institutional policies for influenza vaccination. In addition, the survey asked each center about its vaccination policy for staff and clients, including whether or not increasing vaccinations was an interest/priority for the center. Best subsets algorithms (regression models) were performed to identify factors that may influence CBAS centers' practices on immunization assessment and vaccination. RESULTS: Of the 158 centers, 101 (66 %) completed the survey. A majority did not conduct immunization assessments for influenza (n = 59; 58 %); nearly-two-thirds (n = 70; 71 %) reported it would be feasible to do so if the practice is integrated as part of the individualized/nursing plan of care. Best subsets algorithms showed the strongest factors influencing whether CBAS centers assess for influenza vaccination were: center size, staff training on CAIR, presence of barriers to vaccination, and the belief that it is the center's responsibility to conduct immunization assessments and vaccinations. CONCLUSIONS: Findings suggest that practice gaps in immunization assessment and influenza vaccination are common at LAC's CBAS centers. Closing these gaps may help LAC (and California) improve influenza vaccine uptake and other vaccinations (e.g., pneumococcal, COVID-19) among the most vulnerable of the state's aging populations, Medicare-Medicaid beneficiaries.

Pattern of SARS-CoV-2 variant B.1.1.519 emergence in Alaska.

Alaska has the lowest population density in the United States (US) with a mix of urban centers and isolated rural communities. Alaska's distinct population dynamics compared to the contiguous US may have contributed to unique patterns of SARS-CoV-2 variants observed in early 2021. Here we examined 2323 SARS-CoV-2 genomes from Alaska and 278,635 from the contiguous US collected from December 2020 through June 2021 because of the notable emergence and spread of lineage B.1.1.519 in Alaska. We found that B.1.1.519 was consistently detected from late January through June of 2021 in Alaska with a peak prevalence in April of 77.9% unlike the rest of the US at 4.6%. The earlier emergence of B.1.1.519 coincided with a later peak of Alpha (B.1.1.7) compared to the contiguous US. We also observed differences in variant composition over time between the two most populated regions of Alaska and a modest increase in COVID-19 cases during the peak incidence of B.1.1.519. However, it is difficult to disentangle how social dynamics conflated changes in COVID-19 during this time. We suggest that the viral characteristics, such as amino acid substitutions in the spike protein, likely contributed to the unique spread of B.1.1.519 in Alaska.

Factors Influencing COVID-19 Vaccine Acceptance in the Workplace: Results From a Rapid Survey at 2 Corporations in Los Angeles County, California, 2021.

OBJECTIVES: Achieving widespread vaccine acceptance across various employment sectors is key to a successful public health response to COVID-19, but little is known about factors influencing vaccine acceptance among essential non-health care workers. We examined factors influencing vaccine acceptance among a sample of essential non-health care workers in California. METHODS: We conducted a survey in early spring 2021 at 2 corporations in Los Angeles County, California, to identify and describe factors influencing vaccine acceptance and the ability of incentives to increase this acceptance. We used modified Poisson regression analysis to estimate adjusted prevalence ratios and a best-subset selection algorithm to identify the strongest factors influencing vaccine acceptance. RESULTS: Of 678 workers who completed the survey, 450 were unvaccinated. Among unvaccinated participants, having trust in information about the vaccine from public health experts, having ≥1 chronic health condition related to COVID-19 severity, being Asian, and perceiving risk for COVID-19 were factors that most influenced vaccine acceptance. Most (271 of 296, 91.6%) participants who had trust in information from public health experts and 30.6% (30 of 98) of participants who did not have trust in information from public health experts said that they would accept the vaccine. Seventeen of 24 (70.8%) vaccine-hesitant workers who had trust in information from public health experts and 12 of 72 (16.7%) vaccine-hesitant workers who did not have trust in this information said that they would be more likely to accept the vaccine if an incentive were offered. CONCLUSIONS: Efforts to increase vaccine coverage at workplaces should focus on improving trust in the vaccine and increasing public awareness that the vaccine is free.

Acceptability of telehealth CBT during the time of COVID-19: Evidence from patient treatment initiation and attendance records.

The COVID-19 pandemic provided unique conditions for examining outpatient psychotherapy clinics' rapid transition to telehealth. The current study utilized data from a large, specialty CBT clinic to investigate attendance and treatment engagement changes when services were provided via telehealth versus in-person. Results indicate that, following a complete transition to telehealth services, clinic referrals were maintained. Further, telehealth treatment appeared to be entirely acceptable as assessed by a decreased missed visit rate of telehealth appointments compared to in-person appointments. Given the elimination of commuting times, telehealth has the potential to address disparities in care linked to physical distance from the clinic and/or differential ability to take time off work for appointments.

Early COVID-19 Vaccine Hesitancy Characteristics in Mothers Following Bariatric Surgery.

BACKGROUND: Obesity has played a central role in heightened coronavirus disease 2019 (COVID-19) risk and vaccine response. COVID-19 vaccine intention among those with a history of severe obesity, specifically those who have undergone bariatric surgery, has not been described. This study aims to examine early COVID-19 vaccine intention among mothers with a history of severe obesity who underwent bariatric surgery. METHODS: Sixty-four mothers (Mage = 39.3 years) who underwent bariatric surgery (Mtime since surgery = 19.6 months) completed surveys online (November 2020-February 2021). Information obtained included their COVID-19 vaccine intention (vaccine ready, undecided, vaccine opposed). Analyses examined group differences in demographics, body mass index (BMI = kg/m2), knowledge of obesity-related COVID-19 risk, flu vaccination history, general beliefs about vaccine safety/effectiveness, and factors increasing confidence/motivation to obtain a COVID-19 vaccine. RESULTS: Thirty-six (56.3%) mothers had severe obesity (≥ Class II [BMI = ≥ 35 kg/m2]). The majority were vaccine hesitant (undecided [n = 28; 43.8%]; vaccine opposed [n = 15; 23.4%]). Compared to the vaccine-ready group, vaccine-hesitant groups were younger (p < .05). For the vaccine opposed, recent flu vaccination rates (p = .012) and general belief that vaccines are safe (p = .028) were lower than expected. Among hesitant participants, no reported side effects and the health of self and others were endorsed as top factors increasing vaccine confidence and motivation respectively. CONCLUSIONS: While preliminary, the prominence of early vaccine hesitancy in this sample of mothers who have undergone bariatric surgery, with most persisting with severe obesity, indicates a subgroup at high risk. Factors to address through targeted messaging and intervention were identified.

Patterns of sexual violence against adults and children during the COVID-19 pandemic in Kenya: a prospective cross-sectional study.

OBJECTIVES: This study examined patterns of sexual violence against adults and children in Kenya during the COVID-19 pandemic to inform sexual violence prevention, protection, and response efforts. DESIGN: A prospective cross-sectional research design was used with data collected from March to August 2020. SETTING: Kenya. PARTICIPANTS: 317 adults, 224 children. MAIN MEASURES: Perpetrator and survivor demographic data, characteristics of the assault. RESULTS: Bivariate analyses found that children were more likely than adults to be attacked during daytime (59% vs 44%, p<0.001) by a single perpetrator rather than multiple perpetrators (31% vs 13%, p<0.001) in a private as opposed to a public location (66% vs 45%, p<0.001) and by someone known to the child (76% vs 58%, p<0.001). Children were violated most often by neighbours (29%) and family members (20%), whereas adults were equally likely to be attacked by strangers (41%) and persons known to them (59%). These variables were entered as predictors into a logistic regression model that significantly predicted the age group of the survivor, χ2(5, n=541)=53.3, p<0.001. CONCLUSIONS: Patterns of sexual violence against adult and child survivors during the COVID-19 pandemic are different, suggesting age-related measures are needed in national emergency plans to adequately address sexual violence during the pandemic and for future humanitarian crises.

COVID-19 and Oxygen: Selecting Supply Options in LMICs That Balance Immediate Needs with Long-Term Cost-Effectiveness

From the Document: Medical oxygen therapy is a core part of the treatment of patients with severe COVID-19 [coronavirus disease 2019]. Particularly in low- and middle-income countries (LMICs), where supplies are likely to be inadequate in the face of the pandemic, boosting access to medical oxygen can save lives. Much of the policy debate regarding COVID-19 medical equipment focuses on the question of which form of patient respiratory support is effective in low-resources settings. However, irrespective of the specific form of respiratory support used, the long-term and cost-effective functioning of all forms of oxygen therapy requires an appropriate system to supply oxygen to hospitals. The sustainable and affordable supply of medical oxygen to hospitals has long been neglected in health services, especially in LMICs. With the increased attention to oxygen supply brought by COVID-19, there is an opportunity to build adequate infrastructure to deliver oxygen in a systematic manner.COVID-19 (Disease);Medical supplies