Policy entrepreneurs and individuals: Influence and behavior in pandemic response

Policy entrepreneurs have traditionally been recognized for their ability to influence policymakers by framing policy problems and pairing them with preferred solutions. Does their influence extend to the public? We examine this question in the context of the COVID-19 pandemic in the United States. We analyze whether an individual's perception of a visible, national-level policy entrepreneur, director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci, influences their perceived risk of contracting the virus and their uptake of recommended COVID-19 risk mitigation behaviors. Findings indicate that approval of Dr. Fauci predicts individual risk perceptions and uptake of mask wearing practices, with his influence particularly strong among conservatives. However, Dr. Fauci's influence as a policy entrepreneur waned over time and was moderated by a host of factors such as an individual's worldview, perceptions of policy environment, and media consumption.

The Burden of Hate: How Nonwork Discrimination Experienced During the COVID-19 Pandemic Impacts Asian American Employees.

The COVID-19 pandemic has been accompanied by a sharp increase in prejudice and discrimination targeting Asian Americans in the USA. Thus, in addition to the public health risks associated with the virus, exposure to discrimination poses a unique threat to the health and well-being of Asian Americans. Indeed, empirical evidence has documented the linkage between experiencing anti-Asian discrimination during the pandemic and health decrements among Asian Americans. The goal of this study was to expand that research to also consider the ways experiencing discrimination in a nonwork context may spill over to affect the general and job-related well-being of Asian American employees as well as the potential mitigating role of coworker compassion. Results from a sample of 311 Asian American employees demonstrated that experiencing nonwork discrimination was associated with decrements in physical health and increased depression and job-related exhaustion. Further, there were significant interactions between nonwork discrimination and coworker compassion for engagement, emotional exhaustion, and depressive symptoms such that nonwork discrimination was more strongly related to each outcome when coworker compassion was low. The findings from the current study suggest that experiences of racial derogation, even those that occur outside the workplace environment, are detrimental to the well-being of employees and that coworker compassion is a positive resource that may foster healthier and more inclusive work environments. Supplementary Information: The online version contains supplementary material available at 10.1007/s10869-022-09848-6.

Implementation of virtual interdisciplinary bedside rounds on an acute stroke unit

Background: The novel corona virus pandemic presented the Saskatoon Stroke Program with challenges related to patient- and caregiver-centered communication. Keeping all parties informed of a patient's health status and plan of care in the setting of extreme visitation restrictions was difficult. Virtual interdisciplinary bedside rounds (VIDR) were introduced to enhance communication for stroke patients. Methods: A video conferencing application was adopted by the Saskatchewan Health Authority. Consent to participate was obtained by a social worker. Bedside nurses facilitated patient participation in VIDR on either a tablet or workstation on wheels, while caregivers were able to attend virtually. Each team member accessed the VIDR from an individual device to maintain social distancing. A structured questionnaire has been initiated to capture participant reported experiences and satisfaction with VIDR (data collection ongoing). Results: Most patients and caregivers were amiable to participate in VIDR. Challenges included: accessing appropriate technology for both family and staff members;rural and remote internet reliability;and maintaining a reasonable duration of rounds. There was overwhelming anecdotal positive feedback from participants. Conclusions: We implemented VIDR to enhance communication during the pandemic. Caregivers felt connected to the care team and up-to-date in the plan of care.

Surveillance of Vermont wildlife in 2021-2022 reveals no detected SARS-CoV-2 viral RNA (preprint)

Previous studies have documented natural infections of SARS-CoV-2 in various domestic and wild animals. More recently, studies have been published noting the susceptibility of members of the Cervidae family, and infections in both wild and captive cervid populations. In this study, we investigated the presence of SARS-CoV-2 in mammalian wildlife within the state of Vermont. 739 nasal or throat samples were collected from wildlife throughout the state during the 2021 and 2022 harvest season. Data was collected from red and gray foxes (Vulpes vulples and Urocyon cineroargentus, respectively), fishers (Martes pennati), river otters (Lutra canadensis), coyotes (Canis lantrans), bobcats (Lynx rufus rufus), black bears (Ursus americanus), and white-tailed deer (Odocoileus virginianus). Samples were tested for the presence of SARS-CoV-2 via quantitative RT-qPCR using the CDC N1/N2 primer set and/or the WHO-E gene primer set. Our results indicate that no sampled wildlife were positive for SARS-CoV-2. This finding is surprising, given that most published North America studies have found SARS-CoV-2 within their deer populations. The absence of SARS-CoV-2 RNA in populations sampled here may provide insights in to the various environmental and anthropogenic factors that reduce spillover and spread in North American's wildlife populations.

Breakthrough SARS-CoV-2 infections among patients with cancer following two and three doses of COVID-19 mRNA vaccines: a retrospective observational study from the COVID-19 and Cancer Consortium.

Background: Breakthrough SARS-CoV-2 infections following vaccination against COVID-19 are of international concern. Patients with cancer have been observed to have worse outcomes associated with COVID-19 during the pandemic. We sought to evaluate the clinical characteristics and outcomes of patients with cancer who developed breakthrough SARS-CoV-2 infections after 2 or 3 doses of mRNA vaccines. Methods: We evaluated the clinical characteristics of patients with cancer who developed breakthrough infections using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19; NCT04354701). Analysis was restricted to patients with laboratory-confirmed SARS-CoV-2 diagnosed in 2021 or 2022, to allow for a contemporary unvaccinated control population; potential differences were evaluated using a multivariable logistic regression model after inverse probability of treatment weighting to adjust for potential baseline confounding variables. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. The primary endpoint was 30-day mortality, with key secondary endpoints of hospitalization and ICU and/or mechanical ventilation (ICU/MV). Findings: The analysis included 2486 patients, of which 564 and 385 had received 2 or 3 doses of an mRNA vaccine prior to infection, respectively. Hematologic malignancies and recent receipt of systemic anti-neoplastic therapy were more frequent among vaccinated patients. Vaccination was associated with improved outcomes: in the primary analysis, 2 doses (aOR: 0.62, 95% CI: 0.44-0.88) and 3 doses (aOR: 0.20, 95% CI: 0.11-0.36) were associated with decreased 30-day mortality. There were similar findings for the key secondary endpoints of ICU/MV (aOR: 0.60, 95% CI: 0.45-0.82 and 0.37, 95% CI: 0.24-0.58) and hospitalization (aOR: 0.60, 95% CI: 0.48-0.75 and 0.35, 95% CI: 0.26-0.46) for 2 and 3 doses, respectively. Importantly, Black patients had higher rates of hospitalization (aOR: 1.47, 95% CI: 1.12-1.92), and Hispanic patients presented with higher rates of ICU/MV (aOR: 1.61, 95% CI: 1.06-2.44). Interpretation: Vaccination against COVID-19, especially with additional doses, is a fundamental strategy in the prevention of adverse outcomes including death, among patients with cancer. Funding: This study was partly supported by grants from the National Cancer Institute grant number P30 CA068485 to C-YH, YS, SM, JLW; T32-CA236621 and P30-CA046592 to C.R.F; CTSA 2UL1TR001425-05A1 to TMW-D; ACS/FHI Real-World Data Impact Award, P50 MD017341-01, R21 CA242044-01A1, Susan G. Komen Leadership Grant Hunt to MKA. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).

Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19.

Importance: Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective: To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures: Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures: The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results: The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance: This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration: ClinicalTrials.gov Identifier: NCT04354701.

Community garden practices as indicators of social resilience

Resilience is a simple concept – bouncing back after adversity. However, defining resilience, analyzing, and understanding it is far more complex. The COVID-19 pandemic brought unexpected challenges that rippled through the food system, the social system, and the worldwide economy, exposing many vulnerabilities. It has also illuminated areas of resilience, creativity, and strength. Studies indicate that the act of caring for urban green space (urban environmental stewardship) helps mitigate the social and ecological effects of a system shock. The work done in an urban community garden is an example of urban environmental stewardship. Benefits of urban environmental stewardship and community gardens overlap considerably as both enhance the social, economic, and environmental value of neighborhoods. This mixed-methods study investigated how community gardens, as an example of urban environmental stewardship, contribute to community social resilience, particularly after a system shock. Garden leaders in the Kansas City metropolitan area participated in an online survey, a series of online asynchronous discussion questions, and an online focus group. Discussion questions text and focus group transcriptions were qualitatively analyzed for emerging themes and were guided by the following indicators of community social resilience: place attachment, collective identity, social cohesion, social networks, and knowledge exchange and diversification. We discuss findings from the research and the potential contribution of urban community gardens to community social resilience. © 2022 International Society for Horticultural Science. All rights reserved.

Establishment of SARS-CoV-2 Genomic Surveillance Within the Military Health System During 1 March–31 December 2020

This report describes SARS-CoV-2 genomic surveillance conducted by the Department of Defense (DoD) Global Emerging Infections Surveillance Branch and the Next-Generation Sequencing and Bioinformatics Consortium (NGSBC) in response to the COVID-19 pandemic. Samples and sequence data were from SARS-CoV-2 infections occurring among Military Health System (MHS) beneficiaries from 1 March to 31 December 2020. There were 1,366 MHS samples sequenced from 10 countries, 36 U.S states or territories, and 5 Geographic Combatant Commands, representing approxi-mately 2% of DoD cases in 2020. Genomes from these samples were compared with other public sequences;observed trends were similar to those of Centers for Disease Control and Prevention national surveillance in the U.S. with B.1, B.1.2, and other sub-lineages comprising the dominant variants of SARS-CoV-2. Sequence data were used to monitor transmission dynamics on U.S. Navy ships and at military training centers and installations. As new variants emerge, DoD medical and public health practitioners should maxi-mize the use of genomic surveillance resources within DoD to inform force health protection measures. © 2022, Armed Forces Health Surveillance Center. All rights reserved.

The Burden of Hate: How Nonwork Discrimination Experienced During the COVID-19 Pandemic Impacts Asian American Employees

The COVID-19 pandemic has been accompanied by a sharp increase in prejudice and discrimination targeting Asian Americans in the USA. Thus, in addition to the public health risks associated with the virus, exposure to discrimination poses a unique threat to the health and well-being of Asian Americans. Indeed, empirical evidence has documented the linkage between experiencing anti-Asian discrimination during the pandemic and health decrements among Asian Americans. The goal of this study was to expand that research to also consider the ways experiencing discrimination in a nonwork context may spill over to affect the general and job-related well-being of Asian American employees as well as the potential mitigating role of coworker compassion. Results from a sample of 311 Asian American employees demonstrated that experiencing nonwork discrimination was associated with decrements in physical health and increased depression and job-related exhaustion. Further, there were significant interactions between nonwork discrimination and coworker compassion for engagement, emotional exhaustion, and depressive symptoms such that nonwork discrimination was more strongly related to each outcome when coworker compassion was low. The findings from the current study suggest that experiences of racial derogation, even those that occur outside the workplace environment, are detrimental to the well-being of employees and that coworker compassion is a positive resource that may foster healthier and more inclusive work environments. Supplementary Information The online version contains supplementary material available at 10.1007/s10869-022-09848-6.

IMPACT OF IMMUNOSUPPRESSIVE THERAPIES ON ANTIBODY DECAY FOLLOWING MRNA VACCINATION TO SARS-COV-2 IN A PROSPECTIVE COHORT OF PATIENTS WITH CHRONIC INFLAMMATORY DISEASES

Background: Waning levels of anti-SARS-CoV-2 Spike (S) antibodies, particularly neutralizing, are associated with the risk of breakthrough infections. The impact of immunosuppression on antibody decay kinetics is unclear. We have previously reported a strong correlation between total anti-S antibodies and neutralization titers. Here, we report the decay kinetics in anti-S IgG antibodies across various immunosuppressive medications used in patients with CID. Methods: We recruited a volunteer sample of adults with confirmed CID eligible for SARS-CoV-2 vaccination in a prospective observational cohort study at two United States CID referral centers. All study participants received two doses of mRNA vaccine to SARSCoV- 2. To assess the durability of immunogenicity, anti-S IgG were measured at 7 (visit 3), 90 (visit 5), and 120 (visit 6) days after the 2nd dose of mRNA vaccine. The impact of various medications was assessed in repeated measures mixed model with the patient as a random effect, adjusting for gender and age, and using the group of patients on sulfasalazine, NSAIDs, or on no medications as a reference, using STATA. The half-life of anti-S IgG for a 50 percent reduction in titers at visit 3 was calculated for each medication class. Results: A total of 316 CID patients were recruited of which 148 (46.8%) had inflammatory bowel disease (IBD). Durability was assessed in 495 samples obtained in 293 patients. The arithmetic mean of anti-S IgG antibodies for each medication class at visits 3, 5, and 6 is shown in Figure 1. Overall, a 2-fold reduction in titers was observed from 7 to 90 days and 90 to 120 days (Table 1). The strongest decline was observed among patients on B cell depleting/ modulating therapies followed by those on combinations of biologics and/or small molecules and antimetabolites (methotrexate, leflunomide, thiopurines, mycophenolate mofetil, and teriflunomide). There was modest decline seen with TNFi (half-life 430.5 days, -2.15, 95% CI - 4.31 to - 1.07, p = 0.03). There was also a modest, but not significant, decline seen with Janus Kinase inhibitor (JAKi). No decline was seen with anti-IL-23 or anti-integrin medication classes. Conclusions: Antibody decay in patients with CID is not observed in patients on anti-integrins or anti-IL-23 while it is seen among patients on TNFi, JAKi, antimetabolites, and combinations of biologics and/or small molecules. Our data and those from other cohorts may be used to prioritize medication classes for boosting immunogenicity with additional doses of vaccination against SARS-CoV-2. Collection of antibody titers after booster doses is currently ongoing.(Table Presented) (Figure Presented) Figure 1: Durability of anti-spike IgG antibodies after vaccination against SARS-CoV-2 in patients with Chronic Inflammatory Disease

Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19.

Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anticancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared with control populations of patients with non-B-lymphoid malignancies. Among patients with B-lymphoid malignancies, those who received anticancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared with patients with non-recently treated B-lymphoid malignancies, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19. SIGNIFICANCE: Our study suggests that recent therapy for a B-lymphoid malignancy is an independent risk factor for COVID-19 severity. These findings provide rationale to develop mitigation strategies targeted at the uniquely high-risk population of patients with recently treated B-lymphoid malignancies. This article is highlighted in the In This Issue feature, p. 171.

Reducing Donor Acceptance Practice Variation- Learnings from a Discussion Forum

Purpose: Many acceptable donor hearts are turned down by pediatric centers with varying criteria for an acceptable donor. Advanced Cardiac Therapy Improving Outcome Network (ACTION) and Pediatric Heart Transplant Society (PHTS) centers convened a multi-institutional donor decision discussion forum (DDDF) aimed at assessing donor acceptance practice and reducing practice variation across centers. Methods: The team hosted an hour-long monthly virtual DDDF among pediatric transplant centers across North America, UK and Brazil. Each call had two case presentations posing a donor decision challenge for the presenting center at the time of donor offer. Following each presentation, the attendee group was polled to obtain insight on donor acceptance practices after which the presenting center's decision was revealed. Then, group discussion occurred including a review of relevant literature and latest PHTS data related to the case. Metrics of participation, participant agreement with presenting center decision and impact on future decision making were collected and analyzed. Results: Over 14 months, 23 cases were discussed;an average of 50 physicians, nurses and fellows attended each call. The mean donor age was 8.2 ± 3.3 years (28.6% infants, 52.4% young adults), and the mean recipient age was 8.36 ± 3.3 years (27.3% infants and 40.9% teenagers). Reason for listing was congenital heart disease in 10, cardiomyopathy in 5 and retransplantation in 3. Risk factors influencing decision making included size discrepancy (4), Infection (5), COVID (2), Prolonged QT (2), Malignancy (2), Drugs (2), Distance (1) Prolonged CPR (1) high inotrope use (1) Dialysis (1) Diabetes (1) HLA mismatch (1). Of the 23 cases, 15 were declined by presenting center. Donor characteristics influenced 45% of the decisions and recipient only 20%, with rest being other factors. Participants agreed with the decision made by the presenting center 55% of the times. The post-presentation discussion resulted in 30% of participants changing their original decision. Conclusion: DDDF identified significant variation in pediatric donor acceptance practices;with donor characteristics most influential in decision-making. Given that the discussions changed decisions in 1/3rd of the participants, DDDF may be a useful format to reduce practice variation, provide education to decision makers and eventually increase donor utilization.