Scalable Computational Algorithms for Geo-spatial Covid-19 Spread in High Performance Computing (preprint)

A nonlinear partial differential equation (PDE) based compartmental model of COVID-19 provides a continuous trace of infection over space and time. Finer resolutions in the spatial discretization, the inclusion of additional model compartments and model stratifications based on clinically relevant categories contribute to an increase in the number of unknowns to the order of millions. We adopt a parallel scalable solver allowing faster solutions for these high fidelity models. The solver combines domain decomposition and algebraic multigrid preconditioners at multiple levels to achieve the desired strong and weak scalability. As a numerical illustration of this general methodology, a five-compartment susceptible-exposed-infected-recovered-deceased (SEIRD) model of COVID-19 is used to demonstrate the scalability and effectiveness of the proposed solver for a large geographical domain (Southern Ontario). It is possible to predict the infections up to three months for a system size of 92 million (using 1780 processes) within 7 hours saving months of computational effort needed for the conventional solvers.

Changes in Positive Airway Pressure Use in Adults with Sleep-Related Breathing Disorder during the COVID-19 Pandemic: A Cross-Sectional National Community-Based Survey (preprint)

Purpose: To better understand: i) a positive airway pressure (PAP) therapy use during the pandemic, ii) how PAP use may relate to sleep, health, and COVID-19-related outcomes, and iii) factors associated with PAP use during the pandemic. Methods: This study is based on data collected between Apr 2020 and Jan 2021 as part of the online cross-sectional national community-based survey. The included participants were located in North America, 18 years and older, with self-reported sleep-related breathing disorder (SBD) and usage of a PAP device in the last month before and during the COVID-19 pandemic (“in the past 7 days”). Results: Of all respondents, 7.2% (41/570) stopped using PAP during the pandemic. There were no significant differences between individuals who continued and stopped using PAP in the time elapsed since the pandemic declaration, age, sex, education level, occupational status, family income, or the proportions of individuals endorsing symptoms that could be related to COVID-19. Compared to individuals who continued using PAP, those who stopped had significantly shorter sleep time, lower sleep efficiency, and poorer sleep quality. Higher stress levels and living with someone who experienced symptoms that could be attributable to COVID-19 were independently associated with stopping using PAP. Conclusions: In this survey study, we found that most individuals with SBD continued PAP therapy during the pandemic. However, even 7% of participants who stopped using PAP cannot be ignored. Identifying individuals at risk of discontinuing PAP treatment would help design targeted interventions for patients and health professionals to improve PAP use.

Changes in Positive Airway Pressure Use in Adults with Sleep-Related Breathing Disorder during the COVID-19 Pandemic: A Cross-Sectional National Community-Based Survey (preprint)

Purpose: To better understand: i) a positive airway pressure (PAP) therapy use during the pandemic, ii) how PAP use may relate to sleep, health, and COVID-19-related outcomes, and iii) factors associated with PAP use during the pandemic. Methods: This study is based on data collected between Apr 2020 and Jan 2021 as part of the online cross-sectional national community-based survey. The included participants were located in North America, 18 years and older, with self-reported sleep-related breathing disorder (SBD) and usage of a PAP device in the last month before and during the COVID-19 pandemic (“in the past 7 days”). Results: Of all respondents, 7.2% (41/570) stopped using PAP during the pandemic. There were no significant differences between individuals who continued and stopped using PAP in the time elapsed since the pandemic declaration, age, sex, education level, occupational status, family income, or the proportions of individuals endorsing symptoms that could be related to COVID-19. Compared to individuals who continued using PAP, those who stopped had significantly shorter sleep time, lower sleep efficiency, and poorer sleep quality. Higher stress levels and living with someone who experienced symptoms that could be attributable to COVID-19 were independently associated with stopping using PAP. Conclusions: In this survey study, we found that most individuals with SBD continued PAP therapy during the pandemic. However, even 7% of participants who stopped using PAP cannot be ignored. Identifying individuals at risk of discontinuing PAP treatment would help design targeted interventions for patients and health professionals to improve PAP use.

Stuck in a lockdown: dreams, bad dreams, nightmares, and their relationship to stress, depression and anxiety during the COVID-19 pandemic (preprint)

Background: An upsurge in dream and nightmare frequency has been noted since the beginning of the COVID-19 pandemic and research shows increases in levels of stress, depression and anxiety during this time. Growing evidence suggests that dream content has a bi-directional relationship with psychopathology, and that dreams react to new, personally significant and emotional experiences. The first lockdown experience was an acute event, characterized by a combination of several unprecedented factors (new pandemic, threat of the disease, global uncertainty, , experience of social isolation, exposure to stressful information) that resulted in a large-scale disruption of life routines. This study aimed at investigating changes in dream, bad dream and nightmare recall; most prevalent dream themes, and the relationship between dreams, bad dreams, nightmares and symptoms of stress, depression and anxiety during the first COVID-19 lockdown (April-May 2020) through a national online survey. Methods: 968 participants completed an online survey. Dream themes were measured using the Typical Dreams Questionnaire; stress levels were measured by the Cohen’s Perceived Stress Scale; symptoms of anxiety were assessed by Generalized Anxiety Disorder (GAD-7) scale; and symptoms of depression were assessed using the Quick Inventory of Depressive Symptomatology. Results: 34% (328) of participants reported increased dream recall during the lockdown. The most common dream themes were centered around the topics of 1) inefficacy (e.g., trying again and again, arriving late), 2) human threat (e.g., being chased, attacked); 3) death; and 4) pandemic imagery (e.g., being separated from loved ones, being sick). Dream, bad dream and nightmare frequency was highest in individuals with moderate to severe stress levels. Frequency of bad dreams nightmares and dreams about the pandemic, inefficacy and death were associated with higher levels of stress, as well as with greater symptoms of depression and anxiety. Conclusions: Results support theories of dream formation, environmental susceptibility and stress reactivity. Dream content during the lockdown broadly reflected existential concerns and was associated with increased symptoms of mental health indices.

The New Frontline: Exploring the Links between Moral Distress, Moral Resilience and Mental Health in Healthcare Workers Amidst the COVID-19 Pandemic (preprint)

Background: Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally injurious events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs.Methods: A total of 962 Canadian healthcare workers (88·4% female, 44·6 + 12·8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3 rd and September 3 rd , 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regressions were used to evaluate association between moral resilience, demographic/professional factors and moral distress and to identify factors associated with moral resilience.Findings: Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety and depression symptoms (F > 5·5, p < ·020), and a higher proportion screened positive for mental disorders (Chi-squared > 9·1, p = ·002), compared to healthcare workers who were not. Higher exposure to potentially morally injurious events (B=2·98, 95% CI [2·90, 3·05]) and lower moral resilience (B=3·12, 95% CI [0·04, 6·20]) were associated with worse moral distress. Moral resilience moderated the relationship between exposure to potentially morally injurious events and moral distress (p ·27, pInterpretation: Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.Trial Registration: Data for this study was collected as part of a larger online survey (ClinicalTrials.gov: NCT04369690)Funding Statement: The Royal Ottawa Foundation for Mental Health allocated some funds to help support the wider project from which this study stems. The Royal Ottawa Foundation for Mental Health had no influence on the study design, data collection, analysis, interpretation, or decision to publish this manuscript. The authors have not been paid by any pharmaceutical company or other for profit organization to write this article.Declaration of Interests: CR receives royalties from Oxford University Press: Moral Resilience: Transforming Moral Suffering in Health Care. MG received honorariums for presentations on physician wellness by Amgen and Merck and is the CEO of PEAK MD Inc, through which she delivers keynote presentations, consultation to healthcare organizations, coach senior medical leaders and receive book royalties (unrelated to this research). None of the other authors have any conflict of interest to disclose.Ethics Approval Statement: This study was approved by the Clinical Trials Ontario-Qualified Research Ethics Board (Protocol #2131).

Social, Financial and Psychological Stress during an Emerging Pandemic: Observations from a Population Web-Based Survey in the acute phase of the COVID-19 pandemic (preprint)

BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions. MethodsThis population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohens Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates. Findings6,040/6,685 (90{middle dot}4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12{middle dot}9+6{middle dot}8 before the outbreak to 14{middle dot}9+8{middle dot}3 during the outbreak (p<0{middle dot}001). The independent factors associated with stress worsening were: having a mental disorder, female sex, having underage children, heavier alcohol consumption, working with the general public, shorter sleep duration, younger age, less time elapsed since the start of the outbreak, lower stress before the outbreak, worse symptoms that could be linked to COVID-19, lower coping skills, worse obsessive-compulsive symptoms related to germs and contamination, personalities loading on extraversion, conscientiousness and neuroticism, left wing political views, worse family relationships, and spending less time exercising and doing artistic activities. InterpretationCross-sectional analyses showed a significant increase from average low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with an increase in stress may be informative for intervention development.