Predicting the potential for zoonotic transmission and host associations for novel viruses.

Host-virus associations have co-evolved under ecological and evolutionary selection pressures that shape cross-species transmission and spillover to humans. Observed virus-host associations provide relevant context for newly discovered wildlife viruses to assess knowledge gaps in host-range and estimate pathways for potential human infection. Using models to predict virus-host networks, we predicted the likelihood of humans as hosts for 513 newly discovered viruses detected by large-scale wildlife surveillance at high-risk animal-human interfaces in Africa, Asia, and Latin America. Predictions indicated that novel coronaviruses are likely to infect a greater number of host species than viruses from other families. Our models further characterize novel viruses through prioritization scores and directly inform surveillance targets to identify host ranges for newly discovered viruses.

DELAYED DECLINE: A CASE OF DELAYED POST-HYPOXIC LEUKOENCEPHALOPATHY

CASE: A 44 year old female with history of depression and recent suicide attempt presents with one week of cognitive and functional decline. One month prior to presentation, patient attempted suicide with opioids requiring intubation for respiratory depression and stroke sequelae. She was discharged from this stay after 12 days having returned to mental and functional baseline. Two weeks later, she demonstrated decreased focus and concentration, progressing to decreased mobility and akinesis, eventually presenting to our hospital. Admission metabolic and toxic workup was negative. CT head redemonstrated findings of previously known stroke. MRI demonstrated new increased T2 Flair of the parietal lobes and the cerebral white matter. LP was without evidence of infection or inflammation. Encephalitis panel and autoimmune workup were negative. Neurology consult suggested delayed post-hypoxic leukoencephalopathy as a possible diagnosis, given clinical course of improvement and subsequent decline, along with akinetic mutism and deep cortical white matter flair abnormalities. After failed trial of lorazepam, she was started on amantadine and her cognitive and functional status improved slowly. IMPACT/DISCUSSION: Delayed post-hypoxic leukoencephalopathy (DPHL) is a rare syndrome characterized by biphasic time course with initial recovery and subsequent cognitive and functional decline. DPHL can follow any event of prolonged cerebral hypoxia most frequently CO poisoning. It can occur with more common causes of hypoxia including overdose, cardiac arrest, and seizures;recent case reports have reported DPHL following severe covid infection. The clinical course involves a hypoxic event followed by a return to functional baseline typically lasting 7-21 days, after which progressive physical and mental decline occur. Signs include neuropsychiatric symptoms like amnesia and disorientation, as well as parkinsonism or akinetic mutism (1). The mechanism of DPHL is unclear. One possible mechanisms involves diffuse demyelination. The half life of myelin basic proteins is approximately 20 days, the length of the lucid interval. Hypoxia may abruptly halt the myelination process but symptoms may not emerge until a critical threshold of loss was achieved. Evaluation of DPHL involves considering other causes of encephalopathy, such as infection, substance use, stroke, catatonia, and toxins. In the absence of other causes, diagnosis of DPHL is based on characteristic time course following hypoxic event, symptoms, and MRI findings of diffuse T2 hyperintensity of cerebral white matter are pathognomonic (1). Treatment of DPHL is generally supportive. Limited evidence suggests amantadine may be of benefit. CONCLUSION: Physicians should consider DPHL in patients who have experienced cerebral hypoxia and present with the characteristic time course and imaging findings.

In Situ Calibration of Passive Samplers for Viruses in Wastewater

Wastewater surveillance for SARS-CoV-2 RNAhas rapidly developed worldwide. In low-prevalence settings, sampling in sewage networks is proposed to monitor community transmission. Passive samplers are cost-effective and suitable for catchments where autosamplers cannot be operated. This resulted in their pioneering applications in some countries, even though their sampling kinetics for viruses remains unclear. We conducted in situ calibration of passive sampling materials (membranes, swabs, gauzes, and tampons) for the uptake of pepper mild mottle virus (PMMoV), enterovirus, and human adenovirus 40/41. Passive samplers were deployed in wastewater influent and retrieved sequentially over 48 h. Membranes performed continuous sampling over 48 h with estimated linear sampling rates of 1 mL h-1 for PMMoV, 0.3 mL h-1 for enterovirus, and 33.1 mL h-1 for adenovirus. Tampons and swabs showed a rapid initial uptake of viruses and reached equilibrium after 8 h, while gauze uptake rates were potentially confounded by either inhibitors or viral losses during extended exposure. Additionally, monitoring SARS-CoV-2 at 17 sewer manholes showed that the detection ratio of membranes (14 of 17) was higher than that of tampons (8 of 17). This study demonstrated the ability of passive samplers to retain viral fragments, making them a practical tool for wastewater surveillance for the detection of disease outbreaks in communities. © 2022 American Chemical Society. All Rights Reserved.

BIOLOGICS AND COVID-19 OUTCOMES IN INFLAMMATORY BOWEL DISEASE PATIENTS

Introduction Both clinicians and inflammatory bowel disease (IBD) patients remain concernedthat either their disease or medications—namely biologics, may increase the risk ofsevere adverse outcomes from coronavirus disease-2019 (COVID-19). We performed a systematic review and meta-analysis of the available literature to assess the safety of biologicsin COVID-19 patients with IBD.Methods We performed a systematic review of the databases PubMed/Medline, Embase,Cochrane, Web of Science, LitCOVID-NIH, and WHO COVID-19 from January 1-November3, 2020, to identify relevant articles reporting outcomes in IBD patients with COVID-19.Studies were excluded if they did not report the outcomes of interest (intensive care unit(ICU) admission, mechanical ventilation, and mortality) or excluded data on IBD medications(biologics). Pooled analysis was performed using a random-effects model and multivariateregression was applied.Results The initial search yielded a total of 81 articles, of which a total of 12 studies with2,681 patients were finally included. We found the overall prevalence of outcomes for allIBD patients as: need for mechanical ventilation: 5.1% (95% CI: 3.5%–7.4%, I2 = 52.1%),need for ICU admission: 6.1%, (95% CI: 4.2%-8.8%, I2 = 54.8%), and overall mortality:4.5% (95% CI: 2.8%-7.1%, I2 = 68.0) (Figure 1). Use of biologics did not show a moderatingeffect on the need for mechanical ventilation (coefficient: -0.01, 95% CI -0.08 – 0.05, p =0.68), ICU admission (coefficient: 0.03, 95% CI: -0.02 – 0.08, p = 0.27), or mortality(coefficient: 0.03, 95% CI -0.01 – 0.07, p = 0.20) (Figure 2).Discussion We found the overall prevalence of “severe” COVID-19—mechanical ventilation,ICU admission, and mortality, for all IBD patients with COVID-19 to be 5.1%, 6.1%, and4.5%, respectively. This appears to be fairly low given the impact IBD and its medicationsmay have on the immune-system. We also found that the use of biologics did not predict“severe” COVID-19—as shown upon multivariable analysis from our meta-regression model.This finding is important as it advocates for the ongoing and continued IBD therapy (biologics)in patients during the COVID-19 pandemic. The incidence, severity, and outcomes relatedto COVID-19 in IBD patients needs to be reassessed as data continues to emerge from thepandemic. Additional outcomes data will be required to understand how all classes ofbiologics and/or the use of concomitant immunosuppressants effect COVID-19 outcomesin IBD patients.(Figure Presented)Figure 1. Forrest plot demonstrating the overall prevalence of outcomes—(A) need for mechanical ventilation, (B) need for ICU admission, and (C) overall mortality—in COVID-19 infected inflammatory bowel disease (IBD) patients.(Figure Presented)Figure 2. Scatter plots demonstrating the impact of biologics on outcomes;(A) need for mechanical ventilation, (B) need for ICU admission, and (C) overall mortality.

International Travel and Coronavirus: A Very Early USA-based Study

Tourism and politics are symbiotic. This research, conducted before the impacts of COVID-19 were evident to most Americans, provides insight into the influence one's political persuasion has upon their view toward travel issues related to the disease. The key finding: political tribalism was highly evident, with Republicans, the more conservative USA political party, significantly more supportive of closing the country's borders to those visiting from places where the virus was apparent than were Democratic respondents. Republicans were also considerably less supportive of governmental financial support to hospitality and tourism providers negatively impacted by the then evolving pandemic. Documenting this early glimpse is valuable, helping us better prepare for similar episodes that may follow by depoliticizing actions that are based on health science.

Early results of an in vivo and in vitro allergy testing protocol for COVID-19 vaccinations

Introduction: Mechanisms underlying allergic reactions to the new BNT162b2 (Pfizer) and AZD1222 (AstraZeneca) COVID-19 vaccinations are poorly understood. Polyethylene glycol (PEG) is implicated for BNT162b2;and polysorbate 80 (PS80) and disodium edetate (EDTA) for AZD1222. Methods: Patients referred to our service were investigated with standardised vaccine skin-prick testing (SPT) and intradermal testing (IDT) protocols. Basophil activation testing (BAT) was performed in patients with history highly suggestive of excipient or vaccine allergy. Results: Reason for referral was suspected excipient allergy in 16/23 (70%), previous other vaccine reaction in 4/23 (17%), and reaction to the BNT162b2 vaccine in 3/23 (13%). In patients with suspected excipient allergy, SPT was only positive in 1/16 (6%). In 12/16 patients with suspected PEG allergy, IDT and BAT were positive in 5 (42%) for the BNT162b2 vaccine but not PEG. 3/5 have subsequently undergone successful vaccination with AZD1222, while 1/5 had cross-reactivity with AZD1222 on BAT and has not been vaccinated. 2/16 patients with suspected PS80 allergy were negative on SPT, IDT, and BAT, and have undergone successful AZD1222 vaccination. In the 2/16 patients with EDTA allergy IDT was positive to EDTA but neither vaccine, correlating with BAT. 1 has been successfully vaccinated with the EDTA-containing AZD1222 vaccine. 2 patients (1 reaction to BNT162b2, 1 other vaccine reaction) developed systemic reactions during testing without tryptase elevation. Both were associated with local flare response to the BNT162b2 vaccine, both have undergone successful vaccination with the AZD1222 vaccine. All other patients with negative SPT, IDT, and BAT results have subsequently tolerated vaccination. Conclusion: Most patients can be successfully vaccinated with available COVID-19 vaccines. SPT has low sensitivity and a combined protocol of SPT, IDT, and BAT provides confidence in allergy delabelling. Not all excipient allergies correlate to vaccination allergy and BAT provides a powerful diagnostic tool in these cases.

Patient satisfaction following implementation of a nursing preparation protocol for telehealth visits

Objective: The Covid-19 pandemic prompted broad adoption of telehealth platforms. Our goals were to determine effectiveness of a telemedicine nursing protocol in patient engagement, preparation, and satisfaction. Methods: We implemented a standardized telemedicine nursing protocol prior to a scheduled telehealth visit with a urologic provider at a tertiary care center. Demographic data, telehealth platform and smart device preference, requirement of set up assistance, and rate of success were reviewed. We prospectively administered the Telehealth Usefulness Questionnaire (TUQ), a validated 21-item survey assessing patient satisfaction in 6 domains: Usefulness, Ease of use, Interface quality, Interaction quality, Reliability, and Future use. Scores >105 (>5 for individual items) correlate with high satisfaction. Results: From April - May 2020, 265 patients were included. Demographic data is provided in Table 1. The most commonly used platform for audiovisual visits was Doximity Dialer (85.7%) via Android (50.2%) or Apple (43.0%) smartphone. Eighteen (6.8%) patients reported setup assistance from family/friends. Only 4 (1.8%) were unsuccessful and required conversion to a non-visual phone visit (3 for lack of access to a compatible device;1 for inability to understand instructions). Of these, 186 (70.1%) patients completed the post-visit questionnaire. Mean TUQ scores were 118.31 ± 23.44. Nineteen of 21 individual items had mean scores >5.0. The Usefulness (5.936 ± 1.231) and Interaction Quality (5.89 ± 1.412) subdomains had the highest mean scores. The Reliability subdomain had the lowest mean score (4.715 ± 1.593). Increased TUQ scores were associated with decreased age (P = 0.02) and female gender (P = 0.02). Patients reported high satisfaction with their telemedicine experience regardless of race, marital status, annual income, education level, employment status, or physical distance from clinic but younger age and female gender were associated with greater satisfaction. Conclusions: A standardized nursing protocol designed to maximize patient engagement with telehealth was successful in achieving patient-provider connectivity in 98% of subjects with high patient satisfaction. A team approach to telehealth is recommended.

Making Sense of Emotion-Sensing: Workshop on Quantifying Human Emotions

The global pandemic and the uncertainty if and when life will return to normality have motivated a series of studies on human mental health. This research has elicited evidence for increasing numbers of anxiety, depression, and overall impaired mental well-being. But, the global COVID-19 pandemic has also created new opportunities for research into quantifying human emotions: remotely, contactless, in everyday life. The ubiquitous computing community has long been at the forefront of developing, testing, and building user-facing systems that aim at quantifying human emotion. However, rather than aiming at more accurate sensing algorithms, it is time to critically evaluate whether it is actually possible and in what ways it could be beneficial for technologies to be able to detect user emotions. In this workshop, we bring together experts from the fields of Ubiquitous Computing, Human-Computer Interaction, and Psychology to-long-overdue-merge their expertise and ask the fundamental questions: how do we make sense of emotion-sensing, can and should we quantify human emotions? © 2021 ACM.

Political attitudes and Plog's travel personality model

This research, conducted during the COVID-19 pandemic, applied Stanley Plog's seminal tourism Model of Allocentricity and Psychocentricity and discovered surprising relationships between one's Plog classification and their political attitudes and travel behaviors during the crisis. Though expecting Plog's Allocentrics to have the more politically liberal views and Psychocentrics to be more conservative, we found the opposite to be true. Two previous datasets were revisited, each confirming the relationship. Practical and theoretical implications are discussed. © 2021 John Wiley & Sons Ltd.

Inhaled corticosteroids do not adversely impact outcomes in COVID-19 positive patients with COPD: An analysis of Cleveland Clinic's COVID-19 registry

Rationale Patients with COPD who are afflicted with COVID-19 have an increased risk for adverse outcomes. Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. Given the concern for increased viral shedding related to oral corticosteroids seen with the related coronaviruses MERS-CoV and SARS-CoV-1, our study analyzed the impact of ICS on COPD patients with COVID-19. Methods This study examined 27,810 patients with COPD from the Cleveland Clinic COVID-19 registry between March 8th and September 16th, 2020. We used electronic health records (EHR) to gather patient data on the diagnosis of COPD, ICS use and clinical outcomes. Patients with a concurrent diagnosis of asthma and less than a 10 pack year smoking history, and those aged 35 and younger, were excluded to minimize bias and uncertainty about the diagnosis of COPD. Multivariate logistic regression was used to adjust for demographics, month of COVID-19 testing, and comorbidities known to be associated with increased COVID-19 risk for infection and severe disease. Results Amongst the COPD patients who were tested for COVID-19, 44.1% of those taking an ICS-containing inhaler tested positive versus 47.2% who tested negative (p=0.033). Of those who tested positive for COVID-19 (n=1288), 371 (28.8%) required hospitalization. Comparing the groups of individuals with COPD treated with, and without ICS, there was no significant difference in terms of age (66.9+14.0 vs 67.1+15.0, p=0.92) or gender (38.3% [77/201] vs 46.7% [79/170] males, p=0.13) respectively. In-hospital outcomes were not significantly different when comparing ICS versus no ICS in terms of sepsis (28.4% [57/201] vs 26.5% [45/170], p=0.77), shock (15.9% [32/201] vs 12.4% [21/170], p=0.41), ICU admission (36.8% [74/201] vs 31.2% [53/170], p=0.30), endotracheal intubation (21.9% [44/201] vs 16.5% [28/170], p=0.24), or mortality (18.4% [37/201] vs 20.0% [34/170], p=0.80). Multivariate logistic regression demonstrated that ICS therapy in patients with COPD was associated with less COVID-19 infection (adj OR 0.85, CI: 0.76-0.96);however, there were no significant differences in hospitalization (adj OR 1.12, CI: 0.90-1.38), ICU admission (adj OR: 1.31, CI: 0.82-2.10), need for mechanical ventilation (adj OR 1.65, CI: 0.69-4l02), or mortality (OR: 0.80, CI: 0.43-1.49). Conclusions The lack of adverse outcomes from ICS therapy among individuals with COPD infected with COVID-19 infection as demonstrated in this study, and the known advantages of ICS therapy in lowering the risk of COPD exacerbations, support continuing ICS in individuals with COPD who meet the recommended criteria.

Poster session symptoms associated with COVID-19 positive status in patients with COPD: Looking beyond dyspnea

RATIONALE Patients with COPD (chronic obstructive pulmonary disease) are at high-risk for severe COVID-19 infection. Assessing when these patients should be evaluated for COVID-19 can be difficult because they often have chronic respiratory symptoms such as cough, dyspnea, and sputum production, at baseline. Very little data exists on how patients with COPD present with COVID-19 and which symptoms are associated with a higher risk for COVID-19 infection. The aim of this study was to investigate the symptoms most associated with positive COVID-19 status in patients with COPD. METHODS We investigated 1468 patients with a diagnosis of COPD who were tested for COVID-19 using the Cleveland Clinic COVID-19 registry from 03/8/2020 to 06/08/2020. Testing for COVID-19 at our facility was only indicated for symptomatic patients. We excluded individuals with the concurrent diagnosis of asthma, those with less than a 10 pack-year smoking history, and those 35 years of age and younger to minimize bias and uncertainty about the diagnosis of COPD. Results were analyzed via a multivariate logistic regression adjusted for gender, race, age, smoking status, and comorbidities associated with increased risk of COVID-19 infection (diabetes mellitus, coronary artery disease, hypertension, and history of malignancy). RESULTS Out of a total of 1468 patients, 223 (15.2%) tested positive for COVID-19. Compared to patients with COPD who tested negative, those who tested positive were more likely to endorse fatigue (62.0% vs 40.3%, p<0.001), flu-like symptoms (57.6% vs 36.0%, p<0.001), diarrhea (26.8% vs 17.2%, p=0.009), and loss of appetite (43.5% vs 14.1%, p<0.001). Respiratory symptoms were commonly reported, but not significantly different compared to COVID negative patients (cough: 76.2% vs 75.3%, p=0.88;sputum production: 37.2% vs 32.9%, p=0.43;dyspnea: 75.3% vs 77.9%, p=0.53). When adjusted in multivariate logistic regression, COPD patients had higher odds of testing positive when reporting fatigue (adj OR 2.57, CI: 1.72-3.87), flu-like symptoms (adj OR 2.95, CI: 1.99-4.41), diarrhea (adj OR 2.05, CI: 1.31-3.16), or loss of appetite (adj OR 5.03, CI: 3.19-7.95). CONCLUSIONS In this study, we found that patients with COPD who were tested for COVID-19 demonstrated that constitutional and gastrointestinal symptoms were more often associated with a positive COVID-19 test compared to respiratory symptoms. These findings highlight the importance of investigating additional symptoms other than respiratory in patients with COPD to help predict COVID-19 positivity. .

COVID-19: a shock to the system-reflections from practice by safeguarding adults board managers

Purpose: This paper aims to set out to share the reflections of safeguarding adult board managers as they worked through what is likely to be just the first wave of the coronavirus COVID-19 pandemic. Design/methodology/approach: The paper draws on the experience of small number of safeguarding adult board managers who have provided reflections from practice. Findings: This paper illustrates just some of the responses developed by safeguarding adult board managers and their boards to continue to deliver the work of safeguarding those at risk of abuse and harm in the face of unprecedented impact of the coronavirus COVID-19 pandemic on a key aspect of the safeguarding adult system in England. Originality/value: The reflections reported here are not intended to offer a representative commentary on the experiences of those who oversee and manage safeguarding adults’ boards. It is intention to provide a flavour of some of the challenges and dilemmas faced and some of the creative solutions to address them used by one group of adult safeguarding practitioners. © 2021, Emerald Publishing Limited.

A post-COVID-19 lifestyle sport research agenda: communication, risk, and organizational challenges. (Special Issue: Sport and the coronavirus crisis.)

The cancellations and postponements of large-scale organized sport competitions provided the first indicators of the impact that COVID-19 would have on society. During the pandemic, sport media reporting has focused on cancellations. Although not receiving as much media attention, "lifestyle sports", such as rock climbing, parkour, BMX, kayaking, or skateboarding, were also impacted by COVID-19 in ways that differ from organized team sports. In this commentary, the author draws upon select media reports and subcultural social media posts to highlight two primary impacts of COVID-19: (a) the civic organizational challenges of limiting lifestyle sport participation and (b) the influence on the social and risk-laden experience of these sports. The article concludes by detailing lifestyle sport stakeholder communication, digital sporting communities, the use of social media for organizing lifestyle sport communities, and sport risk communication as fruitful avenues for future research in a postpandemic lifestyle sports.

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa.

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SAgovernment announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes.