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.

Strategies for Prevention of COVID-19 Transmission in Hospitals

Background. Infection control measures against the coronavirus disease 2019 (COVID-19) within a hospital often rely on expert experience and intuition due to the lack of clear guidelines. This study surveyed current strategies for the prevention of the spread of COVID-19 in medical institutions. Methods. Upon systematic review of the guidelines at the national level, 14 key topics were selected. Six hospitals were provided an open survey that assessed their responses to these topics between August 11 and 25, 2020. Using these data, an online questionnaire was developed and sent to the infection control teams of 46 hospitals in South Korea. The survey was conducted between January 31, 2021, and February 20, 2021. Results. All 46 hospitals responded to the survey, and 24 hospitals (52.2%) had treated 100 or more cases of COVID-19. All hospitals operated screening clinics, and the criteria were respiratory symptoms (100%), fever (97.8%), and epidemiological association (93.5%). It was found that 89.1% (41/46) of hospitals allowed symptomatic patients to visit their general outpatient clinics if fever or respiratory symptoms were not associated with COVID-19. Most hospitals (87.2%;34/39) conducted polymerase chain reaction (PCR) tests for all hospitalized patients. Moreover, 76.1% (35/46) of hospitals implemented preemptive isolation policies for hospitalized patients, of which 97.1% (34/35) were released from isolation after a single negative PCR test. A little over half of the hospitals (58.7%;27/46) treated patients that met the national criteria for release from isolation but consistently had positive PCR results. Of these hospitals, 63% (17/27) used N95/KF94 masks, and 40.7% (11/27) used surgical masks without other personal protective equipment for treating them. Most hospitals (76.9%;20/26) accommodated them in shared rooms when the cycle threshold value of the PCR test was more than a certain value (34.6%;9/26), or after a certain period that satisfied the national criteria (26.9%;7/26). Finally, 76.1% (35/46) of hospitals performed emergency procedures or operations on suspected patients. Conclusion. Various guidelines were being applied by each medical institution, but there was a lack of an explicit set of national guidelines to support them.

Urban Park Use During the COVID-19 Pandemic: Are Socially Vulnerable Communities Disproportionately Impacted?

The COVID-19 pandemic altered human behavior around the world. To maintain mental and physical health during periods of lockdown and quarantine, people often engaged in outdoor, physically distanced activities such as visits to parks and greenspace. However, research tracking outdoor recreation patterns during the pandemic has yielded inconsistent results, and few studies have explored the impacts of COVID-19 on park use across diverse neighborhoods. We used a mixed methods approach to examine changes in park use patterns in cities across North Carolina, USA, during the COVID-19 pandemic, with an emphasis on impacts in socially vulnerable communities (based on racial/ethnic composition and socioeconomic status). First, we surveyed a demographically representative sample of 611 urban residents during August 2020 to assess their use of outdoor park spaces before and during the pandemic. Second, we used cell phone location (i.e., geo-tracking) data to document changes in park visits within 605 socioeconomically diverse urban census tracts before (July 2019) and during (July 2020) the pandemic. Data from both methods revealed urban park use declined during the pandemic;56% of survey respondents said they stopped or reduced park use, and geo-tracked park visits dropped by 15%. Park users also became more homogenous, with visits increasing the most for past park visitors and declining the most in socially vulnerable communities and among individuals who were BIPOC or lower-income. Our results raise concerns about urban park use during the COVID-19 pandemic and suggest pre-existing health disparities in socially vulnerable communities might be exacerbated by inequitable access and utilization of parks and greenspace.

Cultural Cognition and Ideological Framing Influence Communication About Zoonotic Disease in the Era of COVID-19

Y The efficacy of science communication can be influenced by the cultural values and cognitions of target audiences, yet message framing rarely accounts for these cognitive factors. To explore the effects of message framing tailored to specific audiences, we investigated relationships between one form of cultural cognition-political ideology-and perceptions about the zoonotic origins of the COVID-19 pandemic using a nationally representative Qualtrics XM panel (n = 1,554) during August 2020. First, we examined differences in attitudes towards science (in general) and COVID-19 (specifically) based on political ideology. We found that, compared to conservatives and moderates, liberals trusted science more, were less skeptical of science, perceived greater risk from COVID-19, were more likely to believe in a wildlife origin of COVID-19, and were more likely to support restrictions on wildlife trade. Second, we examined the influence of cultural framing on the perceived validity of science related to COVID-19. Respondents were randomly assigned to one of three treatment groups: 1) a technocratic framing that highlighted feats of human ingenuity to overcome zoonoses;2) a regulatory framing that highlighted regulations and expansions of protected areas for wildlife as a means to prevent zoonoses, and 3) a control article about traffic lights with no cultural framing. After reading the initial framing article, all three groups read the same fictional, yet factually accurate, 'Nature Science study' generated by the authors. An OLS regression model revealed a significant interaction between the technocratic framing and political ideology. Relative to the control group, the technocratic framing slightly increased perceived validity of the Nature Science study for conservatives, significantly lowered perceived validity for liberals, and had no impact on moderates. We did not detect any significant interaction between framing and political ideology for the regulatory framing. Findings of this study highlight the need to account for cultural cognitions when communicating about COVID-19 and other zoonotic diseases. Communication strategies carefully designed to resonate with ideologically diverse audiences may ultimately lead to bipartisan support for actions required to promote "One Health" approaches that reduce the impacts of zoonoses on human and environmental health.

Health Science Students as PPE Coaches in the Emergency Department - a Pandemic Pilot Project.

PPE is an integral part of reducing transmission of COVID-19. We assessed a 5-week pilot project of utilising health science student volunteers as PPE coaches in the adult and paediatric emergency department (ED) during the pandemic. PPE coaches were provided with training, PPE checklist, area for written observations, and feedback surveys. Overall, correct PPE use improved over time. Coaches felt safe, that training was adequate, and part of the team. Factors that contributed to project effectiveness included institutional support, role clarification, and continuous feedback from staff. Our findings support the utilisation of students in IPC projects.

Patient satisfaction of video consultations in paediatric patients attending a regional neuromuscular clinic

Objective: The impact of the Covid-19 pandemic has been far reaching. Preparing for the wave of acutely unwell patients whilst trying to maintain current patient care is a difficult balance. The paediatric neuromuscular team adapted by providing patient reviews via Microsoft Teams. This survey looks at caregivers views of the teleconferencing system provided and potential pitfalls that may arise in patient care. Method: Email questionnaires were sent out to all of the parents/caregivers who attended the neuromuscular clinic via Microsoft Teams from May 2020 to July 2020. Results: Thirty six were invited for the Microsoft Teams consultations. Three families were unable to use the Microsoft teams due to technical difficulties. Eight out of 33 (24%) attendees responded to the questionnaire. 100% (8/8) reported the technology as "easy to use". 75% (6/8) were "very satisfied" and 25% (2/8) "satisfied" with the service. 88% (7/8) reported less travel, 50% (4/8) reported less waiting and 25% (2/8) reported greater comfort for their child. Negatives included not having access to physical examination (which was cited by 25% (2/8) of respondents). Conclusions: Covid-19 has plunged the healthcare service into availing technology to provide a service for patients. Whilst it is likely that face to face appointments will be required at some stage there is increasing evidence that the majority of clinic assessments can be made via telemedicine and that families and caregivers find this convenient and easy to access with the bonus of saving time, money and hassle.