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The spread of COVID-19 is geographically uneven in agricultural regions. Explanations proposed include differences in occupational risks, access to healthcare, racial inequalities, and approaches to public health. Here, we additionally explore the impacts of coexisting modes of agricultural production across counties from twelve midwestern U.S. states. In modeling COVID-19 spread before vaccine authorization, we employed and extended spatial statistical methods that make different assumptions about the natures and scales of underlying sociospatial processes. In the process, we also develop a novel approach to visualizing the results of geographically weighted regressions that allows us to identify distinctive regional regimes of epidemiological processes. Our approaches allowed for models using spatial weights (e.g., inverse-squared distances) to be meaningfully improved by also integrating process-specific relations (e.g., the geographical relations of the food system or of commuting). We thus contribute in several ways to methods in health geography and epidemiology for identifying contextually sensitive public engagements in socio-eco-epidemiological issues. Our results further show that agricultural modes of production are associated with the spread of COVID-19, with counties more engaged in modes of regenerative agricultural production having lower COVID-19 rates than those dominated by modes of conventional agricultural production, even when accounting for other factors.
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Background: High titer COVID-19 convalescent plasma (CCP) reduces hospitalizations among immunocompetent outpatients. This study evaluated recipient post-transfusion S receptor binding domain (S-RBD) IgG antibody levels and the association of progressing to hospitalization among unvaccinated outpatients with COVID-19 treated with CCP or control plasma. Method(s): This analysis focused on participants from a multicenter doubleblind, randomized, controlled trial comparing treatment of outpatients with COVID-19 convalescent plasma (CCP) or control plasma without SARS-CoV-2 antibodies. Participants with confirmed SARS-CoV-2 infection were transfused within 9-days of symptom onset between June 2020 and October 2021 (n=110 vaccinated control;n=105 vaccinated CCP;n=464 unvaccinated control;n=472 unvaccinated CCP;total n=574 control and n=577 CCP recipients). All subjects had specimens collected the day prior to transfusion (D-1), within 30 minutes after transfusion (D0), 14 (D14), 28 (D28), and 90 (D90) days post-transfusion. Ancestral SARS-CoV-2 S-RBD was measured by an in-house validated ELISA. All 54 COVID-19-related hospitalizations occurred within 2 weeks of transfusion. Result(s): Post-transfusion anti-S-RBD IgG levels on D0 were significantly greater for CCP (median=4 titer,log3) compared to control (median=2 titer,log3;p< 0.001) recipients. Neither sex nor age impacted antibody levels following CCP treatment at D14, D28, and D90. Vaccinated recipients had greater titers than unvaccinated recipients prior to transfusion with little change in titers post-transfusion. Unvaccinated recipients had low antibody titers on D-1 with CCP recipients exhibiting a significant increase in titer from D-1 to D0 compared to controls (mean fold change=1.89;p< 0.001). Among unvaccinated recipients, those who received CCP transfusion late ( >5 days after symptom onset) and had low D0 antibody levels (< 4.24 titer, log3) had the greatest proportion of hospitalizations (5.5%). In contrast, those who received CCP transfusion early (< 5 days after symptom onset) with high D0 antibody levels ( >4.24 titer, log3) had no hospitalizations. Unvaccinated CCP recipient anti-S-RBD IgG antibody levels on D0 correlated with donor anti-S-RBD IgG antibody levels (r=0.30, p< 0.001). Conclusion(s): Among unvaccinated outpatients with COVID-19, CCP recipient antibody dilutional titers after transfusion over 540 titer correlated with protection against hospitalization when transfusion occurred within 5 days of symptom onset. (Figure Presented).
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The COVID-19 pandemic highlighted strengths and challenges of the self-directed care model for home-based long-term care. We discuss policy and practice implications drawing on interviews with over 50 home-and-community-based-services consumers, caregivers, workers, and providers in Kansas. Low-pay, lack of benefits, rising wages in competing sectors, enhanced unemployment and COVID-19 concerns exacerbated workforce shortages that compromised consumer safety and well-being. The lack of budget authority for self-directed consumers in Kansas limited their ability to address these issues. Furthermore, the self-directed model was excluded from emergency funding sources that would have enhanced pay and benefits for workers, including sick pay for quarantine, pointing to the need for targeted funding. Emergency flexibility allowing paid family caregivers addressed care needs for some but is temporary and should be expanded. In the managed care model, MCOs still kept their capitated payment despite significant unfilled care hours, and thus pay-for-performance incentives need to be revisited.
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In the aftermath of COVID-19, remote working has become the norm, and graduates now need an even wider range of skills, which traditional classrooms and internships do not always provide. Working in multiple time zones, within global multi-cultural teams, and only ever meeting colleagues through online technology are just some of the challenges, which require a new type of global graduate. Transversal skills including leadership, collaboration, innovation, digital, green, organization and communication skills are critical. The disruption from COVID-19 also presents unprecedented opportunities to develop more inclusive approaches to internships and international experiences, to level the playing field for students with special needs, from underrepresented groups or with caring commitments. In this position paper, we present a new Global Innovation internship model that has the aim of allowing students to complete technology internships and projects by working together virtually on real world challenges, guided by experienced industry and academic mentors. The model is being developed as part of an Erasmus+ funded project, and the partnership includes seven Higher Education Institutions from six different countries around the world. This position paper describes the design and development of a pilot programme of the Global Innovations internship model. Copyright © 2022 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved.
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SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The World Health Organization defines post-acute sequelae of SARS-COV-2 infection (Long-COVID) as persistent symptoms after COVID-19 for more than two months. Although many studies show associations of comorbidities with prolonged COVID-19 symptoms, to our knowledge, there is no study with a comparison group for Long-COVID. We performed a retrospective study looking at risk factors for the development of Long-COVID. METHODS: We retrospectively reviewed 2,234 records of patients with a history of COVID-19 diagnosed by RT-PCR who followed up as outpatients at multiple pulmonary clinics in Hartford, Connecticut, USA, from March 2020 to December 2021. Data included the patient's age, sex, comorbidities, oxygen device including FiO2 level, and duration of symptoms. We evaluated patient characteristics, duration of symptoms, comorbidities, and disease severity. Analyses comprised the Mann-Whitney U test, χ2 test, or Fisher's exact test Using SPSS v. 26 at an alpha of 0.05. RESULTS: Of the 2,234 patients evaluated, 471 patients were included. The mean age was 56 ± 15 years (± SD), and 62.6% were female. 212 (45%) required hospital admission, and 23 (4.9%) required mechanical ventilation. Of those patients, 351 had symptoms for more than two months (Long-COVID) and 121 for two months or less (no Long-COVID). Both groups had similar characteristics. Hospitalization was more common in the Long-COVID group (51.6% vs. 21.8%, p<0.001). Increased FiO2 requirement was associated with prolonged symptoms (p<0.001), and patients requiring high-flow, non-invasive and invasive ventilation were more likely to develop Long-COVID (p=0.002). The mean duration of symptoms in patients with long-COVID was 7.9 ± 3.9 months versus 0.5 ± 0.8 months in the comparison group (p<0.001). Obesity, asthma, COPD, heart failure, interstitial lung disease, pulmonary hypertension, and immunosuppression were not found to be associated with Long-COVID. Regarding vaccination status, our analysis was limited since only 15 patients were vaccinated prior to developing COVID-19. CONCLUSIONS: Current data on Long-COVID suggests that prolonged symptoms are associated with older age, comorbidities, duration of hospitalization, and ICU stay. Our results, however, suggest that infection severity is the most important factor related to prolonged COVID-19 symptoms rather than comorbidities and age. Our study did contain limitations due to its retrospective nature, subjective duration of symptoms rather than objective 6-minute walk test, and lastly, patients may have been affected by different SARS-COV2 variants and received different treatments. CLINICAL IMPLICATIONS: Our results suggest that patients with severe COVID-19 are more predisposed to develop prolonged symptoms. Based on disease severity, this knowledge can inform providers and patients about prognosis and anticipated duration of symptoms post COVID-19 infection. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar
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SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: The World Health Organization has defined post-acute sequelae of SARS-CoV-2 infection, or Long-COVID, as prolonged symptomatology after initial recovery lasting more than 2 months. Changes in respiratory function associated with this syndrome are not fully understood. Therefore, we performed a retrospective analysis of patients with pulmonary function tests (PFT) after COVID-19. METHODS: We retrospectively reviewed records of 2,234 patients with a history of COVID-19 diagnosed by RT-PCR who followed up in pulmonary clinics in Hartford, Connecticut from March 2020 to December 2021. Data included the patients’ age, sex, comorbidities, PFT results, and the maximum oxygen requirement during acute illness: room air (RA), low-flow oxygen (LF), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or mechanical ventilation (MV). We performed an adjusted logistic regression analysis to evaluate if the disease severity (defined by oxygen requirement) was associated with the presence of obstructive and restrictive disease during follow-up. SPSS 26.0 was used with an alpha level of 0.05. RESULTS: Of the 2,234 records, 471 (21.1%) had available PFTs. Only PFTs done between 2 and 12 months post COVID-19 were included. The mean age (± SD) of the sample was 56 ± 15 years;62.6% were female. Twenty three (4.9%) patients required MV, 17 (3.6%) NIV, 45 (9.5%) HFNC, 111 (23.6%) LF and 275 (58.4%) remained on RA. Obstructive disease was seen in 106 (22.5%), and bronchodilator response was seen in 34 (9.1%). Restrictive disease was seen in 129 (27.4%) and was associated with use of HFNC, NIV and MV (OR: 2.44, 3.67, 3.26;p<0.01). The presence of obstruction did not correlate with disease severity, however use of HFNC did correlate with the absence of obstruction (OR: 0.24;p=0.019). CONCLUSIONS: Our results show a significant association between disease severity and restrictive disease during follow up. This is compatible with smaller studies and is likely related to the fibrotic stage of Acute Respiratory Distress Syndrome. There was an association of HFNC use with the absence of obstruction. Perhaps, patients with the pre-existing obstruction and severe COVID were less likely to tolerate HFNC and required higher support for recovery. Bronchodilator responsiveness was only present in a small portion of patients. Severe disease did not appear to predispose patients to the development of obstructive disease during the follow up period. Studies including pre- and post-COVID PFTs would further strengthen this assertion. CLINICAL IMPLICATIONS: We did find an association between severity of COVID-19 and restrictive disease during follow up. Conversely, disease severity did not correlate with obstruction. These data will help to define the typical course of progression in patients suffering from Long-COVID and may imply that management should mirror strategies employed in other pulmonary conditions that cause restriction. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar
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Rationale: Over 350,000,000 people have had SARS-CoV-2 infection worldwide. COVID-19 poses many challenges in the management of patients causing a long-term and significant burden on the healthcare system. Understanding the long-term complications is a challenge that the healthcare community and patients will face. To our knowledge, this is one of the largest retrospective analyses with the aim to understand the functional lung sequelae of the disease. Methods: We retrospectively reviewed 782 survivors who had COVID-19 diagnosed by RT-PCR and followed up at an outpatient pulmonary clinic in Hartford, Connecticut, USA, from March 2020 to June 2021. Data included patient's age, sex, comorbidities, pulmonary function tests (PFT), the maximal requirement of low-flow oxygen (LF), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) and mechanical ventilation (MV). We performed an adjusted logistic regression model to evaluate if severity of disease according to maximal oxygen support is associated with DLCO<80% in follow-up. SPSS IBM was used for the statistical modeling. Results: Of the 782 patients evaluated, 314 patients had PFT results available post COVID-19 for analysis. The mean age was 58.9±14.5 years, and of the total number of patients, 200 were female (63.7%). Other demographics are as follows: 156 (49.7%) were obese, 129 (41.2%) had asthma, 48 (15.3%) had COPD, 5 (1.6%) had Interstitial Lung Disease, 35 (11.1%) had anemia, 70 (22.3%) had diabetes mellitus, 164 (52.2%) had hypertension, 26 (8.3%) had heart failure. Only 14 (4.4%) required MV, 14 (4.5%) NIV, 29 (9.2%) HFNC, 94 (29.9%) LF and 153 (51.9%) remained on room air. Altered DLCO was seen in 107 patients (34.1%), 189 (60.1%) had normal DLCO, and 18 (5.7%) did not have DLCO, of which the latter were excluded from the analysis. Maximal oxygen support was associated with DLCO<80% on unadjusted analysis (p=0.003). However, it was not associated with DLCO<80% (p=0.2) when adjusted. Other variables associated with a higher risk of DLCO<80% were age (p<0.001) and COPD (p<0.028). Asthma was associated with lower risk of developing DLCO<80% (p<0.001). Conclusion: Patients with post-acute sequelae of SARS-CoV-2 infection can develop DLCO<80%, which may contribute to long-term symptoms. Altered DLCO was not associated with maximal oxygen support in the adjusted logistic regression analysis. However, this may be due to the low number of cases requiring MV or NIV, resulting in selection bias, given there was a higher mortality rate in patients requiring positive pressure ventilation. Additionally, age and COPD were correlated with DLCO<80%.
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Rationale: Effective patient-clinician communication is a central component of high-quality patientcentered care in the intensive care unit (ICU). The Coronavirus Disease 2019 (COVID-19) pandemic has strained critical care delivery systems worldwide and considerably increased burnout symptoms experienced by frontline healthcare workers;however, its influence on patient-clinician communication and therapeutic relationships within the ICU is not well described. Methods: We purposively selected seven hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19 during the winter or spring of 2020. Each dyad included a hospital from the national Veterans Affairs (VA) HealthCare System and its university-academic affiliate. We used semi-structured interviews of intensivists to explore facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships during the COVID-19 pandemic. We then utilized inductive thematic analysis to identify themes describing the influence of the pandemic and hospitals' responses to it on patientclinician communication and therapeutic relationships in the ICU. Results: Overall, 24 intensivists from seven dyads of VA hospitals and academic-affiliate hospitals participated. We identified several barriers and facilitators of patient-clinician communication and the establishment of therapeutic relationships as perceived by intensivists. Barriers included physicians' fear of becoming infected with COVID-19, causing some to minimize contact with patients, and their use of personal protective equipment, which served as an obstacle to effective physical and verbal interactions. Additionally, intensivists noted the disproportionate effect of the pandemic on racial and ethnic minorities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust among patients and their families and compromised physicians' ability to develop therapeutic relationships. Facilitators to patient-clinician communication included the presence of on-site interpreters, use of virtual technology to interact with family members, and designation of a care team member or specialist service (e.g., palliative care) to provide consistent, daily updates to families. Conclusions: The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among racial and/or ethnic minority patients and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances between patients, families, and clinicians in the ICU setting.
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The digitization of financial transactions in both Global North and Global South has led to considerable shifts in how money is used, understood, and processed by users, banks, and fintechs. This shift from physical cash to digital media, accelerated by the COVID-19 push for digital transactions, has impacted how users perceive and use digital money and opened avenues for more data collection. This diverse panel proposes a discussion to understand the set of opportunities and challenges around the design of digital financial services (DFS) and data-driven decision-making in DFS. We will create a live working document starting before the panel to document the discussion, which develops during and after the panel. This live document will enable community to engage with a broader audience of researchers and industry, outlining processes, methods, and tools that researchers and practitioners have created to work with users to develop new equitable DFS and further exploration. © 2022 Owner/Author.
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Objective: To report a 6 year old male who presented with recurrent cerebral infarctions and vertebral artery dissection in the setting of SARS-CoV-2 infection. Method: Case report. Results: A previously well 6 year old male presented with a 2 week history of headache, neck pain and ataxia. SARS-CoV-2 was detected on surveillance nasopharyngeal PCR. Neuroimaging revealed a right inferior parietal cortical infarct with absence of flow in the distal right posterior cerebral artery. CT angiography showed no evidence of vertebral artery dissection or cerebral vasculopathy. He was anti-coagulated initially, and post investigations, discharged home on anti-platelet therapy. He represented 4 weeks later with symptom recurrence. MRI brain on admission displayed a left thalamic infarct. Cerebral angiography showed right vertebral artery dissection with new distal thrombus and bilateral cerebellar infarcts. He was treated with 6 months of LMWH and then changed to antiplatelet therapy. He has had no further events. Thrombophilia, autoimmune and metabolic investigations have been negative. The patient has made a great recovery with minimal circumduction on walking and mild intention tremor. Conclusions: The risk of stroke in young people has been highlighted in the setting of SARS-CoV-2 infection. The reported incidence of cerebrovascular disease in patients testing positive for SARS-CoV-2 ranges from 1% to 6% in the adult population. In the paediatric population, stroke has been reported in children with PIMS-TS also. The proposed mechanism for such events is a hypercoagulable state caused by viral endothelitis, a post infectious immune mediated response or systemic inflammation. Here, we present an unusual case of multiple remote ischaemic strokes in a child who had concurrent asymptomatic SARS-CoV-2 infection without evidence of further organ dysfunction or acute inflammation.
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University-industry R&D collaborations (UICs) are becoming more critical for discovering innovations that can lead to the development of new products, services, and processes and, more broadly, social impact in terms of employment, economic development, and public health. The Covid-19 pandemic, for example, has seen an unprecedented rise in UICs and illustrates how vital their success can be for positively impacting the collaborators involved and society at large. Several challenges face the successful execution of UICs, not the least of which is the cultural difference between the collaborators. Overcoming these challenges is the subject of several research initiatives that seek to identify the critical success factors (CSFs) that UIC consortiums can use to develop their internal capabilities and project management maturity. The challenges facing one large UIC have been studied in Portugal. Practitioners and researchers were involved in generating insights into how the UIC could be more effective. This paper presents some of these challenges facing the UIC and how they were addressed. It also offers early results into the CSFs deemed essential by researchers and practitioners based on their experience together over seven years. Top CSFs include senior management commitment, effective communication, stakeholder engagement, good leadership, clear and realistic goals, mutual trust and respect, interpersonal teamwork, and clear roles and responsibilities. © 2021 Elsevier B.V. All rights reserved.
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The COVID-19 pandemic has greatly influenced all aspects of daily life. Especially hard hit during the pandemic are typically marginalized individuals, including individuals with chronic illnesses and disabilities. Vocational rehabilitation counselors are uniquely positioned to support these individuals both during and after the pandemic. The Illinois Work and Well-Being Model can be utilized by researchers and counselors supporting marginalized individuals as an effective theoretical framework to address anticipated COVID-19-related challenges. In this article we also provide insights into three potential issues that may be more likely to occur as a result of the pandemic. These issues are a delay in career development, an extended absence from work, and experiences of both primary and secondary trauma. We conclude by providing future directions for research that could impact the lives of individuals directly impacted by the COVID-19 pandemic. © 2021 National Rehabilitation Association. All rights reserved.
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Aims To determine the incidence of COVID-19 transmission following outpatient gastrointestinal (GI) endoscopy duringrising community incidence of COVID-19. Methods This prospective study was conducted in a single tertiary referral centre in Dublin. Consecutive patients whoattended the endoscopy unit for a procedure at time points in June, September, and October 2020 were included. Patientsreceived a COVID-19 triage phone call 48 hours before their procedure. COVID-19 testing was not performed beforeoutpatient endoscopy. Inpatients and any outpatient that failed telephone triage were excluded. Standard surgical masks,FFPs and PPE were used by endoscopy staff for all procedures. Patients were contacted 14 days after the procedure toenquire if they had developed symptoms suggestive of COVID-19. Results 522 patients who had GI endoscopy were enrolled, and 506(96.9 %) were contacted for follow up. 163, 157, and186 patients were included in June, September, and October respectively. The mean age was 55.6(range 16-92). Nationallythere were 558, 7430, and 25476 new cases of COVID-19 in June, September, and October respectively. In the two weeks post endoscopy, 7/506(1.3 %) patients required testing for symptoms suggestive of COVID-19. Allpatients had negative results. No member of our endoscopy personnel contracted COVID-19 during the study period. Conclusions This study highlights that the risk of COVID-19 transmission related to GI endoscopy is negligible despitedramatic escalation in community infection.
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BACKGROUND: Healthcare workers (HCWs) are at the front line of the ongoing coronavirus 2019 (COVID-19) pandemic. Comprehensive evaluation of the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among HCWs in a large healthcare system could help to identify the impact of epidemiological factors and the presence of symptoms on the immune response to the infection over time. AIM: To determine the seroprevalence of SARS-CoV-2-specific antibodies among HCWs, identify associated epidemiological factors and study antibody kinetics. METHODS: A longitudinal evaluation of the seroprevalence and epidemiology of SARS-CoV-2-specific antibodies was undertaken in approximately 30,000 HCWs in the largest healthcare system in Connecticut, USA. FINDINGS: At baseline, the prevalence of SARS-CoV-2 antibody among 6863 HCWs was 6.3% [95% confidence interval (CI) 5.7-6.9%], and was highest among patient care support (16.7%), medical assistants (9.1%) and nurses (8.2%), and lower for physicians (3.8%) and advanced practice providers (4.5%). Seroprevalence was significantly higher among African Americans [odds ratio (OR) 3.26 compared with Caucasians, 95% CI 1.77-5.99], in participants with at least one symptom of COVID-19 (OR 3.00, 95% CI 1.92-4.68), and in those reporting prior quarantine (OR 3.83, 95% CI 2.57-5.70). No symptoms were reported in 24% of seropositive participants. Among the 47% of participants who returned for a follow-up serological test, the seroreversion rate was 39.5% and the seroconversion rate was 2.2%. The incidence of re-infection in the seropositive group was zero. CONCLUSION: Although there is a decline in the immunoglobulin G antibody signal over time, 60.5% of seropositive HCWs had maintained their seroconversion status after a median of 5.5 months.