Genotyping SARS-CoV-2 Variants Using Ratiometric Nucleic Acid Barcode Panels.

Designing diagnostic assays to genotype rapidly mutating viruses remains a challenge despite the overall improvements in nucleic acid detection technologies. RT-PCR and next-generation sequencing are unsuitable for genotyping during outbreaks or in point-of-care detection due to their infrastructure requirements and longer turnaround times. We developed a quantum dot barcode multiplexing system to genotype mutated viruses. We designed multiple quantum dot barcodes to target conserved, wildtype, and mutated regions of SARS-CoV-2. We calculated ratios of the signal output from different barcodes that enabled SARS-CoV-2 detection and identified SARS-CoV-2 variant strains from a sample. We detected different sequence types, including conserved genes, nucleotide deletions, and single nucleotide substitutions. Our system detected SARS-CoV-2 patient specimens with 98% sensitivity and 94% specificity across 91 patient samples. Further, we leveraged our barcoding and ratio system to track the emergence of the N501Y SARS-CoV-2 mutation from December 2020 to May 2021 and demonstrated that the more transmissible N501Y mutation started to dominate infections by April 2021. Our barcoding and signal ratio approach can genotype viruses and track the emergence of viral mutations in a single diagnostic test. This technology can be extended to tracking other viruses. Combined with smartphone detection technologies, this assay can be adapted for point-of-care tracking of viral mutations in real time.

Asthma Management Among Children With Food Allergy in the FORWARD Study During COVID-19

Rationale: Asthma remains a significant comorbidity among children with food allergy (FA). Longitudinal data on the course of asthma in this population, particularly during the COVID-19 pandemic, is lacking. This study aims to describe asthma management and control among children with FA during the COVID-19 pandemic. Methods: Children with FA (≤12 years old at enrollment) were enrolled into FORWARD, a prospective, observational cohort study. Data from participants with FA and asthma who completed a 12-month and 24-month post-enrollment asthma therapy assessment were included (n=125). Surveys were administered between January 2019 - July 2022, which includes the onset and duration of COVID-19. Responses to the same questions at the two time points were analyzed using tests of exact symmetry. Results: Compared to the 12-month survey, caregivers at the 24-month survey more frequently reported that their children were not using their inhaler for quick relief (1.6% vs. 9.4%, p = 0.008) and were using their medication incorrectly (3.2% vs. 8.7%, p = 0.003). They less frequently reported that they were unsure whether their medications were useful (3.2% vs. 0.0%, p = 0.016). A similar distribution was observed when non-Hispanic Black and non-Hispanic White participants were compared. No significant differences were evident when comparing symptoms. Conclusions: The symptom burden of asthma remained stable even during the pandemic. However, during this time, children with asthma were less likely to need a rescue inhaler and to be adherent to their maintenance regimen. Further longitudinal research on asthma management is necessary to better understand the potential impact of COVID-19.

Enhancing Preparedness for Emergency Alternative Modes of Instruction: Construction and Evaluation of a Remote Teaching Curriculum

The COVID-19 pandemic and its associated safety recommendations of social distancing provoked an unprecedented shift from primarily in-person to online educational instruction. This paper details a curriculum of eight professional workshops designed to help faculty develop the knowledge and skills to meet their instructional learning goals and students’ accessibility needs in these unique and challenging circumstances. Results identified a number of digital tools and strategies that faculty and students found useful for both synchronous and asynchronous learning contexts. A detailed description of each module as well as faculty-provided recommendations are included herein for the benefit of instructors designing future online courses for alternative modes of instruction. © Springer Nature Switzerland AG 2021.

How Often Are Dental Care Workers Exposed to Occupational Characteristics that Put Them at Higher Risk of Exposure and Transmission of COVID-19? A Comparative Analysis

Objectives: : Occupational characteristics of dental care-including closed environment, proximity to staff and patients and the use of aerosol-generating procedures-put workers at high risk of COVID-19 exposure and transmission. We describe the frequency of workplace situations that potentially increase the risk of exposure to COVID-19 in dental care compared with other occupations including health care. Methods: We conducted a cross-sectional study using sociodemographic and occupational data from the 2016 Canadian census linked to workplace characteristics from the Occupational Information Network (O*NET) dataset. We assessed frequency of workplace indicators using an intensity score from 0 (low) to 100 (high) from O*NET on exposure to infection or disease, physical proximity to others, indoor controlled environments, standard protective equipment and specialized protective equipment. Results: In 2016, 87 815 Canadians worked in the 5 dentistry occupations of interest: dentists;denturists;dental hygienists and dental therapists;dental technologists, technicians and laboratory assistants;and dental assistants. These occupations were routinely ranked in the top 10 of all occupations examined in terms of exposure to workplace indicators that increase the risk of exposure to COVID-19. Dental hygienists and dental therapists, dental assistants, dentists and denturists, rank as the top 4 occupations, in that order, with the highest exposure to disease or infection and physical proximity to others combined. Conclusion: Compared with other occupations, dental care workers are at a higher risk of occupational exposure to COVID-19. These results support the development of workplace guidance to reduce the risk of COVID-19 transmission and enhance the well-being of the dental care workforce.

Extent and causes of increased domestic violence during the COVID-19 pandemic: community health worker perspectives from Kenya, Bangladesh, and Haiti

Background: Emerging data, media reports, and anecdotal evidence suggest that domestic violence (DV) has increased during the COVID-19 pandemic. However, more detailed data are needed on the magnitude, forms, and causes of DV during COVID-19 in different contexts worldwide. We sought to contribute such evidence from the perspective of community health workers (CHWs) in low-middle income countries in three different regions of the world.

Impact of Stewardship on Antibiotic Utilization Rates during the COVID-19 Pandemic: Successes and Challenges in a Regional Hospital

Background. Antibiotic stewardship (AS) is at the core of patient safety and prevention of antimicrobial resistance. Healthcare providers prescribe antibiotics for COVID-19 despite low rates of bacterial co-infection. Our regional hospital had antibiotic utilization (AU) rates higher than other health systems even prior to the emergence of SARS-Cov2. We analyzed the effect AS on AU during the pandemic. Methods. Total and specific AU rates were benchmarked using BD MedMined's medication analytics system from 2nd quarter 2019 to 1st quarter 2021. The AS team released yearly antibiogram and individual prescriber's AU rates and performed weekly, and as needed, review of antibiotic ordering and feedback. To assist in appropriate prescribing decisions, remote educational sessions or mini-lectures and local antibiotic guidelines were developed during the pandemic period. AU rates were monitored quarterly to determine the effects of the AS interventions to prescribing practices. Results. Total and specific AU rates were higher (up to 34% and 80%, respectively) in our index hospital compared to other non-teaching hospitals nationally prior to the pandemic. Total antibiotic utilization increased by only 5.5% in the 2nd quarter 2020, peak of AU during the pandemic. Total, vancomycin, piperacillin-tazobactam and quinolone utilization rates decreased by 19%, 41%, 38%, and 52%, respectively, at 1st quarter 2021 compared to 4th quarter 2019. Steeper decreases were noted with implementation of educational activities. Ceftriaxone use remained high and was 50% greater than comparator hospitals at 1st quarter 2021. Conclusion. Although problematic during the COVID-19 pandemic, AS can have significant impact on provider prescribing practices and decrease total and specific antibiotic utilization rates. The use of ceftriaxone, an antibiotic commonly used for empiric bacterial coverage for community acquired pneumonia, presents as a continuing challenge.

How Often Are Dental Care Workers Exposed to Occupational Characteristics that Put Them at Higher Risk of Exposure and Transmission of COVID-19? A Comparative Analysis

INTRODUCTION: Occupational characteristics of dental care - including closed environment, proximity to staff and patients and the use of aerosol-generating procedures - put workers at high risk of COVID-19 exposure and transmission. We describe the frequency of workplace situations that potentially increase the risk of exposure to COVID-19 in dental care compared with other occupations including health care. METHODS: We conducted a cross-sectional study using sociodemographic and occupational data from the 2016 Canadian census linked to workplace characteristics from the Occupational Information Network (O*NET) dataset. We assessed frequency of workplace indicators using an intensity score from 0 (low) to 100 (high) from O*NET on exposure to infection or disease, physical proximity to others, indoor controlled environments, standard protective equipment and specialized protective equipment. RESULTS: In 2016, 87 815 Canadians worked in the 5 dentistry occupations of interest: dentists;denturists;dental hygienists and dental therapists;dental technologists, technicians and laboratory assistants;and dental assistants. These occupations were routinely ranked in the top 10 of all occupations examined in terms of exposure to workplace indicators that increase the risk of exposure to COVID-19. Dental hygienists and dental therapists, dental assistants, dentists and denturists, rank as the top 4 occupations, in that order, with the highest exposure to disease or infection and physical proximity to others combined. CONCLUSIONS: Compared with other occupations, dental care workers are at a higher risk of occupational exposure to COVID-19. These results support the development of workplace guidance to reduce the risk of COVID-19 transmission and enhance the well-being of the dental care workforce.

Chaotic breathing in post COVID-19 breathlessness: a key feature characterised by approximate entropy

P142 Table 1Baseline characteristics and exercise measurements Post COVID-19 BPD (N = 20) Non-COVID BPD (N = 20) Healthy controls (N = 15) BASELINE CHARACTERISTICS Age/years 41 (10) 49 (14) 50 (18) Gender M:F 6:14 6:14 9:6 BMI (kg/m2) 25 (4) 26 (5) 25 (4) Nijmegen score (/64) 23 (12–44) 23 (14–41) - FEV1 (% pred) 111 (13) 107 (16) 96 (6) FVC (% pred) 118 (14) 114 (16) 107 (12) FEV1/FVC Ratio 80 (6) 78 (6) 75 (12) Resting SpO2 (%) 98 (95–100) 99 (94–100) 97 (96–99) Resting HCO3 − (earlobe) (mmol/L) 24 (5) 22 (3) 24 (2) Resting PaCO2 (kPa) 4.4 (0.8) 4.3 (0.7) 4.7 (0.5) Resting BORG CR-10 dyspnoea (/10) 0.7 (0.8) 1.4 (1.3) 0.2 (0.6) PEAK exercise CPET Variables Duration of test (minutes) 10 (4) 9 (2) 15 (3) Main reason cited for exercise cessation Legs = 6 Legs = 8 Legs = 6 Breathing = 14 Breathing = 12 Breathing = 4 BORG CR-10 dyspnoea (/10) End=5.3 (2.3) End=4.2 (1.5) End=4.1 (1.7) Peak VO2 (L/min) 2.18 (0.87) 1.52 (0.62) 2.77 (1.22) Peak VO2 (% predicted) 106.5 (33.1) 79.8 (17.5) 124.8 (27.3) Peak VO2 (mL/min/kg) 29.6 (7.6) 20.7 (7.1) 37.8 (14.8) Peak Heart Rate (beats/min) 170 (12.6) 141 (26) 167 (15) Heart Rate Reserve (beats/min) 20 (19) 30 (20) 2 (13) Peak VE (L/min) 89 (26) 60 (27) 96 (35) Peak Tidal Volume (L) 2.6 (1.3) 1.86 (0.88) 2.37 (0.71) Peak Breathing Frequency (/min) 43 (23) 31 (9) 33 (8) Peak SpO2 (%) 97 (93–100) 99 (94–100) 95 (73–98) PEAK exercise gas exchange values PaO2 (kPa) 13.3 (3.2) 13.8 (1.2) 13.7 (1.2) PaCO2 (kPa) 4.4 (1.1) 4.2 (0.7) 4.1 (0.7) PETCO2 (kPa) 4.4 (0.6) 4.3 (0.5) 4.8 (0.8) P(A-a)O2 difference (kPa) 2.8 (1.2) 2.1 (0.9) 2.6 (0.9) P(a-ET)CO2 difference (kPa) - 0.10 (0.25) −0.09 (0.37) −0.35 (0.53) Approximate entropy (ApEn) of ventilatory variables during incremental exercise ApEn Tidal Volume 1.61 (0.05) 1.28 (0.23) 1.02 (0.29) ApEn Breathing Frequency 1.40 (0.10) 1.41 (0.20) 1.32 (0.21) ApEn Minute Ventilation 1.22 (0.11) 0.97 (0.30) 0.65 (0.23) Data shown as mean (SD) or median (range);M:F: Male:Female;BMI: body mass index;FEV1: forced expiratory volume in the first second;FVC: forced vital capacity;SpO2;oxygen saturation;CPET: cardiopulmonary exercise test;VO2: oxygen consumption;VE:ConclusionsPost COVID BPD can be characterised by application of non-linear statistical modelling of exercise ventilatory data. This approach now needs further validation to facilitate application in automated CPET equipment, to identify and highlight this important differential diagnosis.

Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles.

N95 respirators and safety goggles are important components of personal protective equipment to reduce the spread of airborne infections, such as COVID-19, among healthcare workers. Poor N95 respirator seal may reduce its protective effect, thereby increasing transmission. Quantitative fit testing is an established way of assessing the N95 respirator fit, which provides a quantitative measure for seal, called the fit factor. Duckbill N95 respirators frequently fail the fit test. We hypothesized that using safety goggles with a wraparound elastic headband will increase their fit-factor by reinforcing the seal between the face and the upper margin of the respirator. We studied the effect of safety goggles with a wraparound elastic headband (3M™ Chemical Splash Resistant Goggles, ID 70006982741) on the fit factor of two types of Duckbill N95 respirators (Halyard FLUIDSHIELD*3, Model 99SA070M, and ProShield® N95 Model TN01-11) in 63 healthy volunteers in a nonrandomized, before-and-after intervention study design. The mean fit factor increased from 69.4 to 169.1 increased from 17/63 (27%) to 46/63 (73%) after the intervention (p <0.0001, OR 3 [95% CI = 4.9-1223]). This is the first study to explore the impact of safety goggles on N95 respirator fit. We conclude that the use of safety goggles with a wraparound elastic headband increases the fit factor of the tested Duckbill N95 respirators. HOW TO CITE THIS ARTICLE: Johns M, Kyaw S, Lim R, Stewart WC, Thambiraj SR, Shehabi Y, et al. Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles. Indian J Crit Care Med 2021;25(9):981-986.

Surveilling and Tracking COVID-19 Patients Using a Portable Quantum Dot Smartphone Device.

The ability to rapidly diagnose, track, and disseminate information for SARS-CoV-2 is critical to minimize its spread. Here, we engineered a portable smartphone-based quantum barcode serological assay device for real-time surveillance of patients infected with SARS-CoV-2. Our device achieved a clinical sensitivity of 90% and specificity of 100% for SARS-CoV-2, as compared to 34% and 100%, respectively, for lateral flow assays in a head-to-head comparison. The lateral flow assay misdiagnosed ∼2 out of 3 SARS-CoV-2 positive patients. Our quantum dot barcode device has ∼3 times greater clinical sensitivity because it is ∼140 times more analytically sensitive than lateral flow assays. Our device can diagnose SARS-CoV-2 at different sampling dates and infectious severity. We developed a databasing app to provide instantaneous results to inform patients, physicians, and public health agencies. This assay and device enable real-time surveillance of SARS-CoV-2 seroprevalence and potential immunity.

A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment

Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor's appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.

A Colorimetric Test to Differentiate Patients Infected with Influenza from COVID-19.

Patients infected with SARS-CoV-2 and influenza display similar symptoms, but treatment requirements are different. Clinicians need to accurately distinguish SARS-CoV-2 from influenza to provide appropriate treatment. Here, the authors develope a color-based technique to differentiate between patients infected with SARS-CoV-2 and influenza A using a nucleic acid enzyme-gold nanoparticle (GNP) molecular test requiring minimal equipment. The MNAzyme and GNP probes are designed to be robust to viral mutations. Conserved regions of the viral genomes are targeted, and two MNAzymes are created for each virus. The ability of the system to distinguish between SARS-CoV-2 and influenza A using 79 patient samples is tested. When detecting SARS-CoV-2 positive patients, the clinical sensitivity is 90%, and the specificity is 100%. When detecting influenza A, the clinical sensitivity and specificity are 93% and 100%, respectively. The high clinical performance of the MNAzyme-GNP assay shows that it can be used to help clinicians choose effective treatments.

Student Teamwork During COVID-19: Challenges, Changes, and Consequences

The COVID-19 pandemic has greatly affected all of society, including teams in organizational settings. Collaborative teamwork is particularly susceptible to pandemic disruptions, as coordination across individuals becomes challenging in socially distanced and virtual contexts. Unfortunately, COVID-19 research thus far has primarily studied individual health and performance. Analysis of 90 open-ended survey responses gives voice to students working in project teams during the pandemic and provides future research directions regarding the multilevel impacts of the pandemic on teamwork. Results reflect three themes: (1) challenges experienced;(2) changes to team communication, tasks, and roles;and (3) consequences to team progress and outcomes.

Cytomegalovirus haemorrhagic enterocolitis associated with severe infection with COVID-19.

We present a case of haemorrhagic enterocolitis in a patient with SARS-CoV-2 who recovered from respiratory failure after support with venovenous extracorporeal membrane oxygenation. We describe clinicopathological features consistent with the systemic coinfection/reactivation of cytomegalovirus (CMV) concurrent with COVID-19 infection and the protracted clinical course of resolution of gastrointestinal inflammation after the treatment of CMV infection. Stool PCR, abdominal CT perfusion scan and histological examination of ileal and colonic tissues excluded enterocolitis secondary to other causes of infection (common viral, bacterial and protozoal gastrointestinal pathogens), macrovascularand microvascular ischaemia and classic inflammatory bowel disease, respectively. We propose possible synergistic pathophysiologic mechanisms for enterocolitis complicating severe COVID-19 infection: (1) T lymphocyte depletion and immune response dysregulation, (2) use of immunomodulators in the management of severe COVID-19 infection and (3) high concentration of ACE-2 receptors for COVID-19 virus in the gastrointestinal tract.

Diagnosing COVID-19: The Disease and Tools for Detection.

COVID-19 has spread globally since its discovery in Hubei province, China in December 2019. A combination of computed tomography imaging, whole genome sequencing, and electron microscopy were initially used to screen and identify SARS-CoV-2, the viral etiology of COVID-19. The aim of this review article is to inform the audience of diagnostic and surveillance technologies for SARS-CoV-2 and their performance characteristics. We describe point-of-care diagnostics that are on the horizon and encourage academics to advance their technologies beyond conception. Developing plug-and-play diagnostics to manage the SARS-CoV-2 outbreak would be useful in preventing future epidemics.