Modeling COVID-19 with big mobility data: Surveillance and reaffirming the people in the data

To better understand the COVID-19 pandemic, public health researchers turned to "big mobility data”—location data collected from mobile devices by companies engaged in surveillance capitalism. Publishing formerly private big mobility datasets, firms trumpeted their efforts to "fight” COVID-19 and researchers highlighted the potential of big mobility data to improve infectious disease models tracking the pandemic. However, these collaborations are defined by asymmetries in information, access, and power. The release of data is characterized by a lack of obligation on the part of the data provider towards public health goals, particularly those committed to a community-based, participatory model. There is a lack of appropriate reciprocities between data company, data subject, researcher, and community. People are de-centered, surveillance is de-linked from action while the agendas of public health and surveillance capitalism grow closer. This article argues that the current use of big mobility data in the COVID-19 pandemic represents a poor approach with respect to community and person-centered frameworks. © The Author(s) 2023.

Clusters of SARS-CoV-2 infection across six schools for children with intellectual and developmental disabilities

Background. In-person learning is important for children with intellectual and developmental disabilities (IDD) because of the additional health, vocational, and functional services for students at these schools. It may be difficult to reduce SARS-CoV-2 transmission in IDD schools because students require assistance with activities of daily living such as eating, during which social distancing and masking cannot occur. Surveillance testing and cluster tracking in schools for children with IDD, which may be considered high-risk environments for transmissions, could have benefits for mitigating transmission and keeping students in schools. The objective of this study was to identify SARS-CoV-2 clusters in IDD specific schools to compare viral transmission in delta and BA.1 variant waves. Methods. A saliva-based PCR test was offered to students and staff for weekly SARS-CoV-2 screening at six Special School District (SSD) schools dedicated to children with IDD. Clusters, which are considered 2 or more positives cases in the same classroom having an epidemiological link, were then recorded. All weekly testing took place between November 23, 2020 and May 27, 2022. Clusters were recorded from November 15, 2021 to January 28, 2022. A Fisher's exact test was used to compare categorical variables. Results. 545 (90%) and 113 (16%) students participated in weekly testing. 160 participants tested positive throughout the study, 23 (14%) during the delta variant wave and 115 (72%) during the BA.1 variant wave. There was no significant variation in age, race, ethnicity, gender, or vaccination status between positive cases recorded from alpha, delta, and BA.1 variant waves (Table 1). Notably, the vaccination rate of positive participants was lower than the vaccination rate of participants who did not test positive. 42 clusters were recorded, 3 (7%) during the delta variant wave and 39 (93%) during the BA.1 variant wave (Fig. 1). Conclusion. The highly transmissible BA.1 variant resulted in an increase in clusters observed in IDD specific schools. Mitigation strategies for less transmissible alpha and delta waves were not as effective in reducing transmission during the BA.1 wave.

Risk factors for 30-day all-cause mortality in hospitalized patients with COVID-19 receiving immunomodulator therapy: a retrospective cohort study

Background. The case fatality rate of patients hospitalized with COVID-19 is estimated at 13-17% with higher rates in the critically ill (37-45%). Attenuation of the inflammatory cascade has potential to reduce mortality. The purpose of this retrospective cohort study was to evaluate risk factors for 30-day all-cause mortality in hospitalized patients with COVID-19 who received tocilizumab or baricitinib. Methods. This was a retrospective cohort study of the first 100 patients that received each medication. Cases were patients with 30-day all-cause mortality from start of immunomodulator, with controls those who received the medication and survived. Patient demographics, laboratory results, vital signs, and clinical management of COVID-19 were evaluated. Inferential statistics were used to analyze risk factors associated with 30-day all-cause mortality. Variables with p < 0.2 on univariate analysis were analyzed via multivariate logistic regression. Results. From February-September 2021, 194 patients treated with an immunomodulator (97 in each group) were evaluated. Patients who received tocilizumab were less likely to be fully vaccinated (4.1% vs. 19.6%, p = 0.001) and were more likely to require mechanical ventilation at baseline (23.7% vs. 11.3%, p = 0.023). There were no between group differences in remdesivir or dexamethasone use. For the primary outcome, 81 patients (41.8%) experienced 30-day all-cause mortality with no difference between groups (tocilizumab: 46.4% vs. baricitinib: 37.1%;p = 0.19). Variables associated with higher odds for 30-day all-cause mortality in multivariate analysis: age >= 65, mechanical ventilation at baseline, and higher daily dexamethasone use. Fully vaccinated patients had lower odds for mortality (Table 1). Conclusion. In COVID-19 hospitalizations, age >= 65, mechanical ventilation at baseline, and higher daily dexamethasone doses were associated with 30-day all-cause mortality. Mortality was lower in patients fully vaccinated compared to those unvaccinated. Use of a specific immunomodulator did not impact mortality.

Resilience, Quality of life, and Wellbeing in intensive care survivors of Covid-19 critical illness

Introduction: The negative impact of Post-Intensive Care Syndrome on the quality of life of critical illness survivors has previously been well characterised.1 Survivors of Covid-19 critical illness are a relatively new cohort in terms of younger age and less prior comorbidity.2 The healthrelated quality of life, psychological problems, resilience, or wellbeing of survivors of Covid-19 critical illness have not been fully explored. Objectives: To characterise the resilience, wellbeing, selfefficacy, and quality of life of ICU-survivors, who were admitted with Covid-19, 6-9 months post-hospital discharge. To explore any potential associations with baseline characteristics. Methods: This was a prospective follow-up study of ICUsurvivor patients who were admitted with Covid-19 and discharged alive from the Royal Infirmary Edinburgh or St John's Hospital, Scotland. Eligible patients were identified by 2 specialist research nurses from the medical records and were contacted via telephone for consent. Paper copies of the questionnaire pack were posted to patients who consented. Demographic characteristics were captured from WardWatcher IT system (age, sex, length of ICU stay). 2 investigators telephoned participants to complete the questionnaires. Outcomes measured were: resilience, using the 10-item Connor-Davidson Resilience Scale (CDRISC), self-efficacy, using the General Self-Efficacy (GSE) Scale, overall health state, using The EuroQol EQ5D-5L Health Questionnaire, and Wellbeing, using 6 10-point visual analogue scales. Statistical analysis was conducted using R-Studio. Associations were tested with Fisher's exact test for categorical variables, and Kruskal-Wallis for continuous variables. Statistical significance was accepted at p<=0.05. Results: Of the 52 eligible patients consented to be contacted, 40 (76.9%) completed the questionnaires. 59.6% (31/52) were male;median age was 59.0 (IQR:53.0-66.2), and participants spent median 6.3 (IQR: 4.1-11.0;) days in ICU. Questionnaires were completed median 202 days (IQR:187.5-224.0) from hospital discharge. The median total CDRISC score was 34.5 (IQR: 30.8-38.0), which has previously been defined as normal resilience (27-37/40)3. 12.5% (5/40) and 32.5% (13/40) reported low (<27/40) and high (>=38/40) resilience respectively.3 The median total GSE score was 34.0 (IQR: 30.0-38.0) (international mean: 29.554). For overall health state (EQ5D-5L), the median overall health score was 80.0% (IQR:75.0-81.2), with the results in each domain as follows: Mobility: 27% (11/40) reported moderate or worse problems (with the remainder reporting no problems);Self-care: 10% (4/40) reported moderate or worse problems;Usual activities: 17% (7/40) reported moderate or worse problems;Pain: 17.5% (7/40) reported moderate or worse problems;Anxiety or depression: 17.5% (7/40) reported moderate or worse problems. For the wellbeing measures, participants rated 'Overall satisfaction with life as a whole' median 8/10 (IQR: 7-9), and 'I have a sense of direction and purpose in life' median 8/10 (IQR:7-9.5). Resilience, self-efficacy, health-related quality of life, and wellbeing were not significantly associated with age, length of ICU-stay, or time between discharge and questionnaire completion. Conclusion: Overall, ICU-survivors of Covid-19 critical illness reported normal resilience, and high levels of selfefficacy and wellbeing at 6-9 months post-hospital discharge. Many ICU-survivors experienced problems affecting their overall health state, such as with mobility and pain. Future studies are indicated to investigate how to best support ICU-survivors in their recovery.

Clinical pharmacist's views on the role of alpha-2-agonists in practice and research for the management of agitation, sedation and delirium (ASD)

Introduction: Patients in the intensive care (ICU) commonly receive analgesics and sedatives to facilitate mechanical ventilation. Recommendations suggest patients are kept as lightly sedated as feasible. Studies report an inconsistent association between deep sedation, prolonged ventilation and ICU stay.1 Opinions around patients 'wakefulness' include discomfort and the potential increased prevalence of psychological morbidity.2 Alpha-2-agonists (clonidine and dexmedetomidine) are agents used in ASD management and reported to produce lighter sedation. The aim of this project was to explore ICU pharmacist's perspective on ASD practice over UK. Objectives: • Explore ICU pharmacist's views on: ASD practices, sedation research priority, importance of A2B clinical trial and the impact of Covid19. • Determine the prevalence of clonidine and dexmedetomidine prescribing. Methods: An online survey was devised on SurveyMonkey. The survey was designed in 2 sections: -1. Respondents provided responses based on a 'point prevalence' of clonidine and dexmedetomidine prescriptions, on day of completion. 2. Their local ICU sedation practice, their views on priority of sedation research, the A2B study and whether they believed ASD was more challenging during the Covid19 pandemic. The online survey was distributed via the UK Clinical Pharmacy Association Critical Care Group (UKCPA CCG), the NIHR Critical Care National Speciality Group (NSG), the UK Critical Care Research Group and Twitter. The survey remained active for 12 weeks from 30.3.2021 with reminders sent for completion every fortnight. Results: There were 121 respondents, all but 1 were ICU pharmacists. There are approximately 243 ICU pharmacist posts in the UK, this represents a response rate of approximately 50%. 37 (30%) of respondent reported clonidine (but not dexmedetomidine) was prescribed in their ICU;7 (6%) described dexmedetomidine only;and 76 (63%) reported both. In describing ASD during Covid-19 pandemic, 107 (88%) respondents reported it had become more challenging. 83 (69%) of respondents stated that clonidine usage increased during the pandemic (27 (22%) no change). 46 (39%) stated that dexmedetomidine usage increased during the pandemic (50 (42%) no change). Among the respondents 98 (81%) 'strongly agreed', and 20 (17%) 'agreed' that research involving ASD is a priority. A2B is set to compare clinical and cost effectiveness of propofol, clonidine, and dexmedetomidine as primary sedative for ICU patients. 49 (40%) of respondents reported participating in A2B. 65 (54%) respondents felt that A2B was a 'very important', and 63 (52%) said it was an 'important' research question. Conclusion: This survey reported widespread use of alpha-2-agonists in ASD practice. Almost two-thirds of ICUs report using both agents. Clonidine use is the most prevalent. Given the paucity of high quality clinical effectiveness and safety data for this drug, clinical trials which assess clinical effectiveness, including ASD are a priority. Respondents endorsed that ASD research is a priority, with ASD management much more challenging during the Covid19 pandemic. Limitations include that the design was a brief online survey;although had a high pharmacist response it did not incorporate the views of other members of the ICU team.

SARS CoV-2 vaccine seroconversion and infection rates in patients on active cancerdirected therapy

Background: Cancer-directed therapy, including cytotoxic chemotherapy and immunotherapy, is a known risk factor for decreased SARS-CoV-2 seroconversion after vaccination, as a result of impaired viral immunity. Outcomes of COVID-19 infection are worse in patients on active treatment, especially those with hematologic malignancies or undergoing stem cell transplantation. The association between cancer subtypes and seroconversion rates is not well established. The goal of this study was to investigate predictive factors for SARS CoV-2 seroconversion and infection. Methods: We reviewed the electronic medical records of all patients with documented SARS CoV-2 antibody levels (between 7/2020-8/2021) in one of the largest integrated health systems in Pennsylvania. Patients who had a diagnosis of hematologic or solid malignancy, were on active treatment (including adjuvant), and had received ≥1 dose of an FDA authorized SARS CoV-2 vaccine were included. Data regarding SARS CoV-2 serology, vaccination, cancer history, and treatment regimens for each patient were collected systematically. Positive serology (reflecting seroconversion) was defined as any value ≥0.8 units/mL. Logistic regression analyses were used to examine predictors of seroconversion. Data was analyzed using SPSS v26 (IBM Corp). Results: A total of 292 patients met the inclusion criteria. Hematologic malignancy was present in 80.5% of the patients and solid tumors in 26.7%. Active disease was present in 71.6% of the cohort. Two vaccine doses were given to 92.5% of the patients and 54.8% of patients received a booster dose (95.2% received mRNA vaccines, either BNT162b2 (Pfizer BioNTech) or mRNA-1273 (Moderna)). A history of COVID-19 infection was present in 15.1% of patients, 59.1% of whom were seropositive. Rates of seroconversion were equivalent in those who received the BNT162b2 (70.2%) or mRNA-1273 (70.9%) vaccines. Seroconversion rates were 69.9% in those with active disease, 81.9% without evidence of disease, and varied by diagnosis as follows (indolent B-cell lymphoma 73.3%, aggressive B-cell lymphoma (BCL) 55.9%, plasma cell dyscrasia 80.1%, CLL 39.5%, myeloid disorder 90.2%, lung cancer 80%, breast cancer 80%, GI cancers 81.3%, and GU cancers 76.9%). On univariate regression, receipt of treatment for CLL (OR 5.79, 95% CI 2.92-11.48, p < 0.001) and aggressive BCL (OR 2.44, 95% CI 1.17-5.09) were predictive of negative serology. Results were not changed on multivariate regression when adjusted for age and active treatment. Conclusions: In this retrospective cohort of vaccinated patients on cancer-directed therapy, treatment for aggressive BCL and CLL was associated with negative seroconversion. In addition, more breakthrough infections occurred in seropositive patients, suggestive of underlying immunodeficiency related to treatment or decreased vaccine efficacy despite formation of virus-specific antibodies.

D Covid-19 e la crisi dell'autocoscienza filosofica

The world pandemic has offered philosophy an opportunity to confront itself - its modes of thinking, self-reflection, and its relation to the world.The pandemic provokes us to question ourselves: what does it mean at this historic moment to be a philosopher, to think about the world, to philosophize in and about it? On one level, the question seems perplexing, for don't we already know what philosophy is and what it means to philosophize? Kierkegaard's equally perplexing question lies at the bottom of my own questioning: what does it mean to be a Christian in 19th century Copenhagen? Is the practice of being a Christian or of doing philosophy merely a conventional routine we have adopted? We have assumed with the deceased Oxford philosopher, Derek Parfit, that what we can offer the world is deep philosophical reflection and clarity about ethical normativity in the contemporary world.But what if the ideal itself of a single, coherent moral theory also proves in vain?. © 2021 Gregorian University Press. All rights reserved.

Ahead of the Curve: Rapid Contagious Disease Modeling

IDA researchers have developed contagious disease modeling capabilities that can be rapidly updated to support civilian and military national security decision makers as they plan, evaluate, and respond to emerging infectious disease outbreaks that have the potential for global spread.

New Models for a New Disease: Simulating the 2019 Novel Coronavirus

On January 30, 2020, the World Health Organization declared COVID-19 a Public Health Emergency of International Concern, which is defined in the 2005 International Health Regulations as an extraordinary event whose potential for international spread requires a coordinated international response. China, where the disease originated, has quarantined tens of millions of its citizens in a bid to mitigate the overwhelming spread of the disease, and countries around the world have instituted screening procedures for travelers from China in an attempt to limit the importation of the disease. As the epidemic progresses, U.S. decision-makers require analytic tools that can be rapidly updated to reflect the continuous influx of new disease knowledge to help plan, evaluate, and respond to the emerging situation.

Navigating a Calculus Course During a Pandemic: A USMA Perspective

In this article we analyze publications written about different teaching modalities and evaluate how each applies to a calculus class during the on-going COVID-19 pandemic. We focus on the positives and negatives of teaching and learning in a virtual, classroom, or HyFlex environment. Although arguments could be made for each environment, especially given different institutional objectives, this work aims to explain why we eventually preferred teaching our Fall 2020 multivariable calculus course in a face-to-face classroom setting at the United States Military Academy at West Point. We also offer measures of performance to compare the current COVID-19 semester with previous semesters. The results support two major conclusions drawn from our decision to teach in-person under in a time constrained environment: learning modality matters in mathematics and this pandemic will influence student-teacher interaction for semesters to come.

SARS-CoV2 spike protein can activate platelets through integrin alpha iib beta 3

Background : Patients with severe coronavirus disease 19 (COVID-19) are at increased risk of thrombosis, which can be a challenge to manage and is associated with elevated mortality. The virus responsible for COVID19, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), is unique amongst coronaviruses that infect humans in that its envelope spike protein includes an arginine-glutamateaspartate (RGD) peptide sequence in its receptor-binding domain (RBD). In platelets, RGD sequences are recognised by the main platelet activation and adhesion integrin, α IIb β 3 , triggering integrin activation, outside-in signalling, and platelet activation. Aims : To investigate whether the RGD sequence in the spike protein is able to activate platelets through integrin a IIb b 3 . Methods : Fibrinogen, collagen, purified spike and RBD protein were coated on glass slides and platelets were allowed to adhere under static or flow conditions. Slides were washed, stained platelets with ActinGreen and imaged by confocal microscopy. Results : Purified SARS-CoV2 spike protein and RBD protein triggered platelet spreading and this was blocked by incubating the platelets with the clinically used non-peptide RGD mimetic α IIb β 3 -integrin blocker, tirofiban. In an in vitro thrombosis model using healthy donor blood, we find surprisingly that this ability to activate platelet integrins does not translate into an enhancement in thrombus formation on collagen, and platelets cannot form thrombi on the spike protein under arterial or venous conditions. Conclusions : We conclude therefore that although SARS-CoV2 spike contains an RGD sequence that can activate platelet integrins, whether this contributes to enhanced thrombosis under pathological conditions in Covid-19 patients is not known. Structural analysis of the RGD site suggests a buried location in the spike, which may be revealed by other activatory mechanisms and receptors, and which will require further study.

COVID-19 pneumonia in patients with hematologic malignancies-a report from the us epicenter

Background: Limited data are available for risk assessment and outcome of COVID-19 in patients with hematologic malignancies (HM). We present a single center study of COVID-19 pneumonia in a cohort of 31 patients with HM. Methods: Data were abstracted from electronic medical records for patients admitted to NYPH between 3/5/20 and 4/17/20 and entered into a REDCap database. Results: Twenty (64.5%) were male;median age was 71 years. There were 8 patients with Multiple Myeloma (MM), 8 with Chronic Lymphocytic Leukemia (CLL), 6 (19.4%) had AML, 5 (16.1%) NHL, 2 (3.2%) ALL;CML, MDS and Polycythemia Vera occurred in 1 patient each. Twenty-four (77.4%) had active HM;6 (19.4%) were in remission;and 1 relapsed. Nineteen patients (61.3%) received recent chemotherapy and 11 (35.5%) immunosuppressive therapies. There were 7 (22.6%) hematopoietic stem cell transplant (HSCT) recipients (4 allogeneic and 3 autologous). Comorbidities were evenly distributed among all malignancies: 18 (58.1%) had hypertension, 9 (38.7%) obesity, 7 (22.6%) diabetes mellitus, and 11 (35.5%) were former smokers. The most common symptoms included cough (90.3%), fever (83.9%) and dyspnea (61.3%);7 (22.6%) had nausea and vomiting;7 (22.6%) had diarrhea. On presentation, hypoxia (O2 sat ≤94% on room air) occurred in 64.5%;median ALC was 330/ml;23 (74.2%) had ALC< 1000/ml;median CRP was 15.9 mg/dl (2.5-40.4), ferritin 1162 ng/ml (264 - > 16500), and D-dimers 456 ng/ml (< 150-2418). Thirteen patients (41.9%) required ICU admission and were intubated;among those 9 (69.2%) had either MM or CLL. Co-infections were uncommon;two patients developed HSV1 pneumonitis and one of these also had CMV pneumonitis. Twenty-eight (90.3%) were treated with hydroxychloroquine, 5 (16.1%) remdesivir, 2 (6.5%) tocilizumab, 1 (3.2%) sarilumab, and 4 (12.9%) with methylprednisolone 0.5mg/kg Q12h. Seventeen patients (54.8%) recovered and were discharged, 12 (38.7%) died;2 (6.5%) were still hospitalized but left the ICU. Conclusion: In our cohort, there were predominantly more patients with MM and CLL and 56% of these were intubated;larger cohort studies will further define the risk and outcome for COVID-19 in patients with HM.

Surgical morbidity during covid-19 pandemic-a gynaecology oncology persective

Introduction COVID-19 has had significant repercussions on the provision of oncological surgical services worldwide. Within any Gynaecological Oncology service, careful consideration needs to be given when weighing up peri-operative risks & potential inpatient exposure to COVID-19 versus the risk of delaying surgery. Often, for these patients, deferral of surgery may result in disease progression. Since March 2020, we identified 118 Gynaecological Oncology patients referred to the Ireland East Gynaecological Group between the Mater Misericordiae University Hospital (MMUH) & St. Vincent's University Hospital (SVUH) for whom major oncological surgery was deemed clinically urgent. To minimise peri-operative morbidity and the risk of onward hospital transmission of COVID-19, screening questionnaires were administered before hospital admission. These screened for epidemiological risk, symptoms, recent travel & contacts. If asymptomatic, testing for SARS-CoV-2 was not performed. Methods We analysed the clinical data of the above 118 patients to determine their baseline characteristics/risk factors for COVID-19, suspected diagnoses, surgical procedures & 7- day morbidity. Results This cohort consisted of ovarian (n=57), endometrial (n=41), cervical (n=6) and vulvo-vaginal (n=14) cancer patients. 44% of cases were laparoscopic and 18% were major cytoreductive surgeries. All patients screened were deemed asymptomatic & low risk- therefore proceeded to surgery. 49 (41.5%) patients had a defined risk factor for COVID-19. 7- day post-operative morbidity was 13% (N=16). 3 patients met symptomatic criteria for COVID-19 testing post-operatively, however none tested positive. Conclusion Careful patient selection based on risk factors and symptoms allows units to continue to perform safe oncological surgery during a pandemic.

Outcome Disparities Among Men and Women With COVID-19: An Analysis of the New York City Population Cohort

BACKGROUND: Growing evidence suggests a possible sex disparity in COVID-19 disease related outcomes. OBJECTIVE: To explore the sex disparity in COVID-19 cases and outcomes using New York City (NYC) population level data. SETTING: NYC surveillance data from February 29 to June 12, 2020. PARTICIPANTS: Individuals tested for COVID-19 in metropolitan NYC.Outcome Measurements and Statistical Analysis: Outcomes of interest included rates of COVID-19 case positivity, hospitalization and death. Relative risks and case fatality rates were computed for all outcomes based on sex and were stratified by age groups. RESULTS AND LIMITATIONS: 911,310 individuals were included, of whom 434,273 (47.65%) were male and 477,037 (52.35%) were female. Men represented the majority of positive cases (n=106,275, 51.36%), a majority of hospitalizations (n=29,847, 56.44%), and a majority of deaths (n=13,054, 59.23%). Following population level adjustments for age and sex, testing rates of men and women were equivalent. The majority of positive cases and hospitalizations occurred in men for all age groups except age >75 years, and death was more likely in men of all age groups. Men were at a statistically significant greater relative risk of case positivity, hospitalization, and death across all age groups except those <18 years of age. The most significant difference for case positivity was observed in the 65–74 age group (RR 1.22, 95%CI 1.19–1.24), for hospitalization in the 45–65 age group (RR 1.85, 95% 1.80–1.90), and for death in the 18–44 age group (RR 3.30, 95% CI 2.82–3.87). Case fatality rates were greater for men in all age-matched comparisons to women. Limitations include the use of an evolving surveillance data set and absence of further demographic characteristics such as ethnographic data. CONCLUSION: Men have higher rates of COVID-19 positivity, hospitalization, and death despite greater testing of women;this trend remains after stratification by age. J Drugs Dermatol. 2020;19(10):960-967. doi:10.36849/JDD.2020.5590.