Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021.

OBJECTIVE: To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN: We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS: Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS: Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER: NCT04061382.

Adaptations and innovations: analyzing food system organizations' responses to the ongoing COVID-19 pandemic

During the global COVID-19 pandemic, food systems have been affected by supply-chain disruptions, shifting employment trends, and increasing prices that change organization and business operations, increase food insecurity, and influence the broader economy. Much of the early scholarship regarding pandemic trends pointed to root causes in the corporate food regime and called for seeing the crisis as an opportunity for transformational change. Relying on surveys and in-depth interviews with food system stakeholders, this paper describes the impact of the COVID-19 pandemic on food businesses and organizations in Charlotte, North Carolina, USA. We examined the challenges created during the pandemic and related responses by stakeholders. Our research found that the pandemic's impacts have been mixed. Most stakeholders identified both barriers and opportunities, reporting great upheaval and disruption but also new opportunities for innovation and collaboration. We argue that, while many positive innovations and quick responses were generated, ongoing challenges are indicative of widespread food system vulnerabilities created by a corporate food regime that produces thin margins while limiting the ability of stakeholders to pursue transformational change. Much of the existing literature considers the pandemic's effects on individual producers and eaters, as well as large-scale structural shifts, yet less attention has been paid to the responses of food system organizations and businesses. This research contributes to food systems literature through its focus on food system actors to better understand how the food system is changing during the pandemic.

Virtual wobble spaces: A pilot study of the outcomes of online therapeutic spaces on practitioner well-being and social work practice

Wobble rooms are physical spaces, often within hospitals and health care settings where staff can go to have a 'wobble.' They were set up largely as a response to the Covid-19 pandemic, and are therefore different in style and content, with some wobble rooms containing basics, whilst others host therapy animals and creative activities. Some wobble spaces were also established online. Evaluations of existing wobble spaces show that accessing a dedicated space, activities and sharing with others have positive effects on staff well-being. Despite this, the wobble space model does not appear to have been extended from health care into social work. This article describes a small pilot research study, delivered over three months, at fortnightly intervals, with social workers from the same UK authority. The study drew inspiration from the 'Weeble' a 1970's toy which could 'wobble but not fall down' and offered participants a safe place to meet, share and experiment with creative activities. Evaluations from the study show that participants experienced positive effects on both individual well-being and wider practice and suggest that there is scope for the model to be extended in social work more widely, alongside support methods such as coaching or counselling.

Evaluating and Improving Questions on an Unproctored Online General Chemistry Exam

Administering exams in large enrollment courses is challenging and systems in place for accomplishing this task were upended in the spring of 2020 when a sudden transformation to online instruction and testing occurred due to the COVID-19 pandemic. In the following year, when courses remained online, approaches to improve exam security included measures like using test banks and reducing the allotted time for completing exams to reduce the sharing of information. A psychometric comparison using classical test theory of an unproctored online exam with one delivered in-person indicates both have comparable reliability. However, item-level analysis demonstrates some questions performed higher in the unproctored setting, with an important variable being the item's searchability online. Revising questions to increase generalizability and reduce searchability mitigate these performance differences. Further, changing the format for questions involving calculations from multiple-choice to open response with random number generation was found to increase difficulty and item discrimination and is a viable approach for improving exam security. © 2022 Authors.

Field-Based Environmental Chemistry Course for Interdisciplinary, Project-Based Learning

Faculty in the Chemistry and Environmental Science programs at St. Mary's University in San Antonio, Texas, collaborated to develop an undergraduate course in Field-Based Environmental Chemistry. The course was developed and implemented as a 2-semester, 1-semester, and online, synchronous course offered during the 2020/21 COVID-19 pandemic. As part of the course, chemistry and environmental science majors designed and executed a sampling and laboratory analysis plan for monitoring the physical and chemical conditions of soil and/or water in a local, urban setting. As part of a goal to help students develop communication skills, they presented their work to stakeholders from the local community. Through participation in an active learning model, students demonstrated significant gains in the student learning outcomes. Students in the 2 semester sequence showed gains in their understanding of the scientific process, more comfort with the uncertainty and the ambiguity of natural environments, and appreciation for the importance of statistics in data analysis. The online course and COVID-19 pandemic restrictions did not allow for student field or laboratory work but did engage students in a project typical of a work environment.

IMPROVING ACCESS TO INPATIENT AMBULATORY CARDIAC MONITORING FOR ACUTE STROKE PATIENTS DURING THE COVID-19 PANDEMIC

Introduction Ambulatory cardiac monitoring (ACM) identifies atrial fibrillation (AF) in 10.7% of patients with ischaemic stroke and no prior history of the condition. Prior to the Covid-19 pandemic, there was limited access to inpatient ACM. During the pandemic the stroke unit was provided with rapid access to inpatient ACM. Aims 1. To examine the number of inpatient and outpatient ACM performed during the pandemic and the number of these which positively identified AF. 2. to measure the mean waiting time for the ACM. Methods The records of patients in the six months prior to (n=118) and the five months during the pandemic (n=354) were analysed. Results The proportion of ACM performed as an inpatient increased from 21% to 59% during the pandemic. Inpatient rapid access ACM identified AF in 6% of patients (vs. 0% previously) and all were anticoagu-lated within 14 days of their stroke. Waiting times for inpatient ACM decreased from a mean of 17 to 4 days during the pandemic. Discussion There was a significant shift in clinical practice and diagnostic access to inpatient ACM during the pandemic, resulting in a greater proportion of tests, increased identification of AF and early anticoagulation, leading to improved patient care and potentially preventing further ischaemic events.

Walking the tightrope: avoiding a lockdown while containing the virus

This paper finds that although containment policies can successfully reduce the spread of the virus, they can also have a substantial impact on reducing mobility and economic activity. It also shows that testing, combined with effective contact tracing, is crucial in reducing the spread of the virus, especially at relatively low levels of infection, and that mask-wearing and the protection of the elderly population in general and those in care homes in particular, might play an important role in combatting the virus while minimizing economic costs.

Covid-19 vaccine does not increase the likelihood of disease exacerbation in ibd: Results from a population-based study

Background: While short-term safety data of COVID-19 vaccination has been reassuring, it is theoretically possible that the vaccineassociated immune activation could trigger immune dysregulation and thus exacerbation of IBD. We used the epi-Israeli IBD Research Nucleus (IIRN) database to perform a population-based study exploring the effect of COVID-19 vaccination on disease course in IBD patients. Methods: We included all IBD patients insured in two of the four Israeli HMOs, covering 35% of the population, by validated algorithms, and selected those who received two doses of Pfizer BNT162b2 vaccine. These were matched to unvaccinated IBD patients by demographics, parameters of disease severity at baseline generated by hierarchical clustering of laboratory data, and length of time from previous exacerbation to baseline. The primary outcome was rate of IBD exacerbation as defined by proxies of hospitalizations, treatment escalation, and commencement of corticosteroid or enema. The study period was December, 2020 to June, 2021 Results: 707 pairs of vaccinated and unvaccinated IBD patients were compared. The pairs matched exactly for gender, district, IBD type and disease severity, and ±1 year for age at IBD diagnosis and at vaccination. Mean age was 38.5±13.5 years and median follow-up was 98 days (IQR 16-143). No difference in the outcome was found between the groups from the 2nd vaccination to the end of follow-up, with risk of exacerbation in vaccinated patients of 29% and risk in unvaccinated patients 26% (p=0.3). Conclusion: COVID-19 vaccinated IBD patients demonstrated a rate of IBD exacerbation following vaccination that was no different from that of unvaccinated patients. The multifaceted immune activation induced by the vaccine did not result in worsening IBD disease course. These results provide further reassurance for IBD patients receiving the vaccine.

COVID-19 vaccine effectiveness in inflammatory bowel disease patients on tumor-necrosis factor inhibitors: Real world data from a massvaccination campaign

Background: Some studies have shown decreased serological response to vaccination in patients on anti-tumor necrosis factor (TNF) medications. While the large majority of these patients do seroconvert after vaccination, titers have generally been lower and one study showed reduced neutralizing and inhibitory functions. One real-world population- based study compared found no increased infection rate in anti- TNF treated patients, but infection rates were low. The low event rate mandates exploration in longer-term population-based data. We used the epi-Israeli IBD Research Nucleus (IIRN) database to explore the effectiveness of COVID-19 vaccination in IBD patients in Israel. Methods: We included all IBD patients insured in two of the four Israeli HMOs, covering 35% of the population, by validated algorithms, and selected those who received two doses of Pfizer BNT162b2 vaccine. These were matched by date of vaccination ±3 days and demographic variables to non-IBD controls. The primary outcome was incidence of positive COVID-19 PCR following vaccination between December, 2020 to June, 2021. Results: 12,640 IBD patients received two vaccine doses;the matched cohort included 4,946 matched pairs (total 9,892 subjects). Mean age was 50.5±16.1 years and median follow-up was 22 weeks (range 4.1-24.4). Fifteen (0.3%) vaccinated IBD patients tested positive compared with 15 (0.3%) vaccinated non-IBD controls (OR=1 [95%CI 0.49-2.05], p=1.0). Patients on anti-TNF and/or corticosteroids did not have a higher incidence of positivity - neither compared to the entire group nor to IBD patients treated with vedolizumab/ustekinumab, even after precise matching for demographics, underlying diseases and IBD severity. Conclusion: In a large population-based cohort of IBD patients in Israel, vaccine effectiveness was equivalent to non-IBD controls and was not influenced by treatment with anti-TNF or corticosteroids. Notwithstanding previous findings of impaired serological response in anti-TNF treated IBD patients, this real-world large-scale study shows that vaccine protection is robust in IBD patients, including those on immunosuppressive medications.

Mild COVID-19 disease among children with inflammatory bowel disease: An update from the secure-IBD registry

Background: Children who develop coronavirus disease 2019 (COVID-19) tend to have a mild disease course, although a small percentage develop more severe disease and/or multi-organ inflammatory syndrome. Children with inflammatory bowel diseases (IBD) are often treated with immune suppressive medications that may increase their risk of complications from infection. We describe the disease course of COVID-19 in children with IBD based on updated data from the SECURE-IBD database. Methods: The Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) was created in March 2020 to monitor outcomes of COVID-19 occurring in IBD patients and includes cases from the parallel Paediatric IBD Porto group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). We included all subjects ≤18 years of age from the SECURE-IBD database through May 18th, 2021. We used descriptive statistics to summarize the demographic and disease characteristics of the study population, both overall and stratified by hospitalization status (hospitalized versus outpatient only), and performed bivariate comparisons. We performed a post-hoc logistic regression analysis evaluating the association of sulfasalazine/mesalamine use and hospitalization while adjusting for disease activity. Results: We collected 540 COVID-19 cases in pediatric IBD patients from 35 countries. The most common IBD treatment was TNF antagonist monotherapy (48%), followed by sulfasalazine/mesalamine (21%). Most patients (86%) had no comorbidities other than IBD. There were no deaths in the study population, and 14 children (4%) were hospitalized, of whom only two (0.4%) required mechanical ventilation. Both children requiring mechanical ventilation were on mesalamine, had ulcerative colitis, and were 6 and 7 years old, respectively. Factors associated with hospitalization included comorbid conditions other than IBD (35% hospitalized vs 13% not;p value <0.01), moderate/severe IBD disease activity (57% vs 14%;p value <0.01 overall), gastrointestinal symptoms (65% vs 16%, p value <0.01), Hispanic ethnicity (30% vs 14%;p value 0.03), sulfasalazine/mesalamine use (39% vs 21%;p value 0.03), and steroid use (26% vs 6%, p value <0.01). TNF antagonist monotherapy was associated with a decreased likelihood of hospitalization (22% vs 49%;p value 0.01) (Table). Sulfasalazine/mesalamine use was not a significant a risk factor after adjusting for disease activity (aOR 2.19, 95% confidence interval 0.86-5.55). Discussion: In this updated and expanded analysis of an international COVID-19 reporting registry, we observed that children with IBD have a relatively low risk of severe COVID-19, even while receiving immune suppressive IBD treatments. These findings may reassure families of children with IBD and inform decisions regarding return to school and activity.

Seroprevalence of SARS-CoV-2 antibodies in patients with autoimmune inflammatory rheumatic diseases

OBJECTIVES: To assess the prevalence of anti-SARS-CoV-2 antibodies in autoimmune inflammatory rheumatic disease (AIIRD) patients, and to define clinical factors associated with seropositivity. METHODS: A cross sectional study was conducted at a tertiary rheumatology department in Israel. Consecutive patients completed a questionnaire and were tested for SARS-CoV-2 anti-nucleoprotein IgG (N-IgG). If this was positive, an anti-S1/S2 spike IgG (S-IgG) test was done. If both were positive, the patient was considered seropositive. Seropositive patients were retested after 3 months. RESULTS: The study included 572 AIIRD patients. Thirty patients were found seropositive, for a seroprevalence of 5.24%. The seropositive rate was significantly lower for patients treated with immunosuppressive medications (3.55%, p<=0.01), and specifically for patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) (2.7%, p<=0.05). These associations remained significant in the multivariate regressions adjusting for age, sex and exposure to a known COVID-19 patient. A second serology test 3 months later was collected in 21 of the 30 seropositive patients. In a mean+/-standard deviation (SD) of 166.63+/-40.76 days between PCR and second serology, 85% were still positive for N-IgG, and 100% were still positive for S-IgG, with a higher mean+/-SD titre compared to the first S-IgG (166.77+/-108.77 vs. 132.44+/-91.18, respectively, p<=0.05). CONCLUSIONS: Humoral response to SARS-CoV-2 in AIIRD patients may be affected be immunosuppressive treatment, especially bDMARDs. In patients with AIIRD, titres of SARS-CoV-2 IgG antibodies, especially N-IgG antibodies, fade with time, while S-IgG antibodies persist.

Seroprevalence of SARS-CoV-2 antibodies in autoimmune inflammatory rheumatologic patients

Background: Immune responses in AIIRD patients may be reduced and influenced by immunosuppressive treatments[1].The effect of immunosuppression on the mounting of SARS-CoV-2 antibodies in AIIRD is not clear. Objectives: To assess the prevalence of SARS-CoV-2 antibodies in AIIRD patients and to define clinical factors affecting this prevalence. Methods: Consecutive consenting AIIRD patients from the Rheumatologic department in Tel Aviv Medical Center participated in the study. Patients answered a questionnaire and were tested for SARS-CoV-2 antibodies. A two stage antibody testing was done in order to increase specificity. Results: The study included 560 AIIRD patients (229 RA, 149 PsA, 84 SLE, 55 vasculitidies, 40 SpA, 3 other CTD), of them 26 patients were found to have SARS-CoV-2 IgG antibodies (4.6%) (Table 1). This was more than double than aprevious prevalence in the same clinic population studied after the first wave of the pandemic in Israel, which was 2.07% (accepted for publication). A lower rate of immunosuppression was found for positive SARS-CoV-2 IgG patients compared to negative serology patients (Table 1, p=0.009). There was also a trend for the subgroup of patients on biologic DMARDS (26.92% vs. 47% respectively, p=0.06). Positive SARS-CoV-2 PCR test was reported and confirmed in 36 patients, of them 14 (38.89%) had negative serology. Patients who did not have antibodies had numerically more than double rates of glucocorticoids and bDMARDs treatment. The time between positive PCR test to positive serology test was significantly shorter (mean±standart deviation 75.57±40.44 days) than the time between positive PCR to negative serology test (130.79±86.47 (p=0.04) (Table 1 and Figure 1) suggesting a fading of the antibody response with time. Conclusion: The prevalence of SARS-CoV-2 IgG was 4.6% in a population of AIIRD patients from a single tertiary medical center in Israel. SARS-CoV-2 seroprevalence tended to be low among AIIRD patients on immunosuppressive treatment, including in patients with a confirmed history of positive SARS-CoV-2 PCR, similar to other studies [3]. As in individuals without AIIRD, the mounting of SARS-CoV-2 IgG seems to fade with time. Larger studies are needed to confirm the potential effect of immunosuppression on the antibody response in AIIRDs.

An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study.

BACKGROUND: This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions. METHODS: Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R. RESULTS: About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61-31.34). CONCLUSIONS: There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.

How Has the COVID-19 Pandemic Affected Outdoor Recreation in the US? A Revealed Preference ApproachJEL codes

This study examines the effects of the COVID-19 pandemic on outdoor recreation trips and values using revealed preference data in the context of travel cost method. Demand models are estimated using data on pre- and postpandemic trips reported in a nationwide survey of recreation participants. The models incorporate related subjective risk perceptions as postpandemic measures of site quality and account for household-level factors, pre-existing conditions, and risk tolerance. Our results suggest that the pandemic had negative effects on recreation visits and values, with risk-tolerant households and households with pre-existing conditions taking more trips.

Postscript: COVID-19 and elephant tourism, a preliminary analysis

The COVID-19 pandemic had major and rapid consequences for tourism, ending almost all activity and causing immense problems for elephant tourism. This postscript provides an early review of the evolving situation. It looks at the effects of COVID-19 on international tourism and on elephant tourism camps, as well as the implications for poaching.

Erratum: Testing in the Time of COVID-19: A Sudden Transition to Unproctored Online Exams (J. Chem. Educ. (2020) 97: 9 (3413-3417) DOI: 10.1021/acs.jchemed.0c00546)

The article, Testing in the Time of COVID-19: A Sudden Transition to Unproctored Online Exams, was originally published without including Richard Spinney as an author. However, Richard Spinney made a significant scientific contribution to this work, authoring the code available as part of the Supporting Information of the paper, and his name should be included in the list of authors. © 2020 American Chemical Society and Division of Chemical Education, Inc.