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The COVID-19 pandemic has escalated the risk of SARS-CoV-2 transmission in the dental practice, especially as droplet-aerosol particles are generated by high-speed instruments. This has heightened awareness of other orally transmitted viruses, including influenza and herpes simplex virus 1 (HSV1), which are capable of threatening life and impairing health. While current disinfection procedures commonly use surface wipe-downs to reduce viral transmission, they are not fully effective. Consequently, this provides the opportunity for a spectrum of emitted viruses to reside airborne for hours and upon surfaces for days. The objective of this study was to develop an experimental platform to identify a safe and effective virucide with the ability to rapidly destroy oral viruses transported within droplets and aerosols. Our test method employed mixing viruses and virucides in a fine-mist bottle atomizer to mimic the generation of oral droplet-aerosols. The results revealed that human betacoronavirus OC43 (related to SARS-CoV-2), human influenza virus (H1N1), and HSV1 from atomizer-produced droplet-aerosols were each fully destroyed by only 100 ppm of hypochlorous acid (HOCl) within 30 s, which was the shortest time point of exposure to the virucide. Importantly, 100 ppm HOCl introduced into the oral cavity is known to be safe for humans. In conclusion, this frontline approach establishes the potential of using 100 ppm HOCl in waterlines to continuously irrigate the oral cavity during dental procedures to expeditiously destroy harmful viruses transmitted within aerosols and droplets to protect practitioners, staff, and other patients.
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BACKGROUND: There is a need for a specific programme of engagement around COVID-19 vaccination with the Charedi Orthodox Jewish community in Stamford Hill, London, UK. We co-produced a live event for women on COVID-19 safety and vaccination and wider health topics to support vaccine uptake and improve awareness of health and wellbeing issues. METHODS: For this qualitative analysis, we organised an event that was designed and delivered by a local community organisation in partnership with regional and local health partners and community groups. The event was for Charedi women aged 16 years and older, and provided information on COVID-19, childhood immunisations, oral health and dental hygiene, childhood respiratory infections, and mental health. The event included health stalls, a panel session, co-designed culturally competent physical information, and the opportunity to speak with health professionals. We evaluated the event using attendees' feedback forms, collected in person at the end of the event, and a thematic analysis of semi-structured interviews with organisers from community and statutory organisations. The evaluation was informed by a co-produced logic model and outcomes framework. FINDINGS: More than 100 women attended the event on March 28, 2022. Feedback suggested the focus on wider health issues was valued, and a greater number of more targeted events (eg on health for women older than 40) would be beneficial. Dental health, COVID-19 vaccination, and childhood immunisations were identified as the most important topics by participants. 16 (55%) of 29 respondents stated they would attend a similar event again, 12 (41%) stated they were unsure, and one (3%) said they would not attend again. Informal feedback from the community highlighted that the event was useful and acted as a basis for further engagement and collaboration with the community. INTERPRETATION: Our findings emphasised the need to work in partnership with a lead community organisation to identify and address principal health challenges within communities, to share community-specific insights, and to promote community events through community communication channels. Statutory institutions should engage with local community organisations to support and facilitate public health interventions to increase relevant vaccine uptake and to improve awareness around wider health and wellbeing issues and services. FUNDING: None.
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In 2020, the Namibian Ministry of Health and Social Services (MoHSS) and the Robert Koch Institute (RKI) started a twinning project with the long-term goal of establishing a Namibia Institute of Public Health (NIPH). A fundamental pillar of an NIPH is a fully operational Public Health laboratory system. Due to the COVID-19 pandemic, the need for strengthening the existing Namibian Laboratory system became eminent. Following the Intra-Action Review (IAR) of the COVID-19 response in Namibia in 2020, three regional diagnostic laboratories, at points of entry, were assessed. The major issues identified were long delays between sampling of both suspected cases and COVID-19 patients and receiving test results due to extended sample transport times to the central laboratory in Windhoek and the overload of the central capacities due to overwhelming numbers of samples during peak times. This led to the establishment of three SARS-CoV-2 PCR diagnostic laboratories through procurement and installation of equipment, provision of consumables/reagents, and on-site training of laboratory technicians with continued virtual technical support. Consequently, an important reduction of the diagnosis turnaround time was achieved. Of great value was the technical support given by the staff at the central laboratory during the trainings allowing for immediate validation of the newly established laboratories and to strengthen the communication between regional laboratories and the central laboratory. The Namibian molecular diagnostic capacities have increased in important regions in Namibia and will provide data to support the health policies of the future NIPH. New diagnostic protocols will be developed to foster the sustainability of the established laboratories and could support the implementation of genomic surveillance capacities. Finally, stronger relationships were built through these joint activities, which will support and the next steps of the establishment of the NIPH. Key messages • Supporting and Strengthening the Namibian Public Health Laboratory system. • Long-term goal of establishing a Namibia Institute of Public Health (NIPH).
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Introduction: The rapid development and deployment of SARSCoV- 2 vaccines elevated reliance on pharmacovigilance to inform benefit-risk assessments and national vaccine policy recommendations. During the mass vaccination program against pandemic coronavirus, the VAERS received an unprecedented number of adverse event reports. The VAERS database doubled in size in 2021 and accumulated 856,340 SARS-CoV-2 vaccine reports (54.3% of all VAERS reports) as of May 6, 2022 (HHS 2022). This publicly available resource has been heavily relied upon to inform US vaccine policy. Objective(s): To understand how VAERS has been used to study the safety of the SARS-CoV-2 vaccines. Method(s): Publications containing the terms "Vaccine Adverse Event Reporting System" or VAERS and COVID-19 or SARS-CoV-2 were identified from PubMed. Non-research articles, publications that did not use VAERS or did not study SARS-CoV-2 vaccines, and withdrawn publications were excluded. Key data fields were ed from the remaining articles and summarized through descriptive statistics. Result(s): 88 publications were identified with 27 excluded upon review;1 was withdrawn, 9 were commentaries/editorials, and the remainder did not study SARS-CoV-2 vaccines in VAERS. Approximately one-half of the 61 included publications focused on one or more Adverse Events of Special Interest (e.g., anaphylaxis, facial nerve palsy, Guillain-Barre syndrome, myocarditis/pericarditis, etc.) or death rather than all events or signal detection. Several special populations were studied including children, adolescents, and "pregnant persons." Methods ranged from constructing a case series for clinical review to modeling. Adverse event reporting rates were calculated in 36 studies (58%). Denominators were derived from state or national vaccine administration data (CDC 2022), and included estimates of doses administered, number of persons vaccinated, and person-years. In more than one-third of the publications that calculated adverse event reporting rates, these values were misreported or misinterpreted by the study authors as estimates of incidence rates or cumulative incidence (risk). Conclusion(s): The rapid nationwide SARS-CoV-2 vaccine rollout resulted in an unprecedented volume of VAERS reports, which have been relied upon to investigate rare adverse events and inform vaccination policy. The methods and scientific rigor of vaccine adverse event studies varied considerably. Despite the inability to calculate incidence or risk using voluntary adverse event reports, these terms were frequently used instead of, or interchangeably with, reporting rate. Where a causal relationship exists, relying on reporting rates as a proxy for incidence may substantially distort estimates of harms (Weiss 2022).
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Purpose : The disruption of COVID-19 has caused differential impacts on vulnerable populations. This study tested the hypothesis that persons with visual impairment in Ann Arbor and Detroit, MI faced increased difficulty in their daily lives since summer 2020 during the pandemic compared to normally sighted individuals. Methods : We administered the Coronavirus Disability Survey (COV-DIS) to assess general and psychological health, isolation, financial and transportation challenges, information access and instrumental activities of daily living. Our study population included 112 adults recruited from the University of Michigan (UM) Health System and 151 adults recruited from the Henry Ford Health System (HF) in Detroit, MI with moderate or worse visual impairment (<20/60 in better-seeing eye), and 160 age/sex-matched controls (C). The COV-DIS was administered via phone or email. The UM IRB approved this study and all participants provided informed consent. Results : There were no significant site differences in age or visual acuity of participants. Participants with visual impairment at Henry Ford (VIHF) lived in more disadvantaged neighborhoods (higher Area Deprivation Index) compared with UM participants with visual impairment (VIUM) (66 VIHF 52 VIUM;p<.01). All groups reported similar overall health prior to the pandemic. However, a greater proportion of VIHF participants reported somewhat or much worse health than pre-pandemic compared with VIUM or controls (C) (25% VIHF, 10% VIUM, 12% C;p=.003). Participants with visual impairment had more difficulty accessing medical care since the start of the pandemic (13% VI, 6% C;p=.049). One-quarter of participants reported difficulty obtaining trusted information during the pandemic;those with vision impairment were more likely to find the information hard to understand (10% VI, 3% C;p=.01). Conclusions : COVID-19 and associated mitigation measures had differential effects on populations with visual impairment. Participants with visual impairment in Detroit were more likely to report a negative impact on their health than participants from Ann Arbor, MI. Those with visual impairment in both locations faced greater challenges accessing medical care and trusted and understandable information related to the pandemic. This information may be helpful for shaping health policy to address the barriers faced by individuals with visual impairment.
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Introduction: The rapid development and deployment of SARSCoV-2 vaccines elevated reliance on pharmacovigilance to inform benefit-risk assessments and national vaccine policy recommendations. During the mass vaccination program against pandemic coronavirus, the VAERS received an unprecedented number of adverse event reports. The VAERS database doubled in size in 2021 and accumulated 856,340 SARS-CoV-2 vaccine reports (54.3% of all VAERS reports) as of May 6, 2022 (HHS 2022). This publicly available resource has been heavily relied upon to inform US vaccine policy. Objective: To understand how VAERS has been used to study the safety of the SARS-CoV-2 vaccines. Methods: Publications containing the terms "Vaccine Adverse Event Reporting System" or VAERS and COVID-19 or SARS-CoV-2 were identified from PubMed. Non-research articles, publications that did not use VAERS or did not study SARS-CoV-2 vaccines, and withdrawn publications were excluded. Key data fields were ed from the remaining articles and summarized through descriptive statistics. Results: 88 publications were identified with 27 excluded upon review;1 was withdrawn, 9 were commentaries/editorials, and the remainder did not study SARS-CoV-2 vaccines in VAERS. Approximately one-half of the 61 included publications focused on one or more Adverse Events of Special Interest (e.g., anaphylaxis, facial nerve palsy, Guillain-Barre syndrome, myocarditis/pericarditis, etc.) or death rather than all events or signal detection. Several special populations were studied including children, adolescents, and "pregnant persons." Methods ranged from constructing a case series for clinical review to modeling. Adverse event reporting rates were calculated in 36 studies (58%). Denominators were derived from state or national vaccine administration data (CDC 2022), and included estimates of doses administered, number of persons vaccinated, and person-years. In more than one-third of the publications that calculated adverse event reporting rates, these values were misreported or misinterpreted by the study authors as estimates of incidence rates or cumulative incidence (risk). Conclusion: The rapid nationwide SARS-CoV-2 vaccine rollout resulted in an unprecedented volume of VAERS reports, which have been relied upon to investigate rare adverse events and inform vaccination policy. The methods and scientific rigor of vaccine adverse event studies varied considerably. Despite the inability to calculate incidence or risk using voluntary adverse event reports, these terms were frequently used instead of, or interchangeably with, reporting rate. Where a causal relationship exists, relying on reporting rates as a proxy for incidence may substantially distort estimates of harms (Weiss 2022).
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The Kidney Disease Quality of Life (KDQOL) survey is a review of patients’ quality of life (QOL) on hemodialysis. Lower survey scores in depression, burden of disease, and treatment satisfaction are associated with worse compliance to treatment and poorer outcomes. KDQOL surveys were extracted from and stratified by year, with duplicate entries removed. Annual mean scores for each component of the survey were calculated for each clinic. The KDQOL data represents the mean scores for 2017-2019 compared to the first three quarters of 2021. 2020 was excluded due to sampling challenges and high patient turnover creating potentially inaccurate data. Mean scores were compared by Student’s t-test with Bonferroni adjustment for multiplicity. Phosphorus and PTH levels were used as a surrogate for treatment compliance. Patients reported lower QOL scores during the COVID-19 pandemic compared to pre-pandemic (baseline). All KDQOL metrics were significantly lower in 2021 compared to the mean of three years prior to the pandemic. A two sample Student’s T test was used to determine the change in mean score for each category: Physical Component Score (t(2)= 14.5, p=0.009), Mental Component Score (t(2)= 36.7, p=0.0004), Burden of Kidney Disease (t(2)= 6.1, p=0.01), Symptoms of Kidney Disease (t(2)= 22.8, p=0.0009), Effects of Kidney Disease (t(2)= 8.8, p=0.006). Phosphorus was significantly higher in 2021 compared to the mean of 2018 and 2019 when calculated via t-test (t(31)= -2.72, p=0.01). Parathyroid Hormone quarterly data was evaluated via t-test for 2018 to 2020 vs. the first three quarters of 2021 (t(12)= -7.15, p=0.01) Using the KDQOL survey to measure patients’ QOL, we found that all measures were significantly lower in 2021 following the pandemic. Using markers of bone metabolism as measures of treatment compliance, phosphorus and PTH levels were also significantly higher in 2021. In ESRD patients who survived the trauma of the pandemic, QOL is perceived to be worse and is likely affecting compliance. Social workers and staff need to be aware of these trends to provide the appropriate counselling and resources to meet the needs of these patients.
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Allergen Immunotherapy (AIT) is a safe therapy approved for patients with allergic rhinitis, allergic asthma, and atopic dermatitis.
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Background: Health advice in the wake of the COVID-19 pandemic has called upon the public to re-evaluate risk associated with recently routine behavior. However, differences in demographics, situational circumstances, and psychological dispositions create inequities in how people are able to respond to risks presented by the virus. Method: Within a sample of 482 Americans, we examined the frequency of behavior reconceptualized as 'risky' by CDC public health guidelines released on 30 March 2020. We applied a cluster analysis using a data-driven persona framework from the field of user-design research, using only situational and dispositional (i.e. psychological) variables to identify profiles of individuals.
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Introduction: The COVID-19 pandemic presented exceptional challenges to caring for adults with sickle cell disease (SCD) and necessitated a rapid transition to telemedicine, disrupting established care systems within a population that already faces unique and challenging medical needs. Although implementation of telemedicine care assumed reliable patient access to the requisite technology, as well as adequate spaces in which to complete visits, pre-pandemic barriers to in-person visits were also considerable, and many patients lacked access to reliable transportation and childcare or could not afford to miss work to attend clinic. Given the scarcity of research on the acceptability of telemedicine care for SCD patients, the pandemic has provided a critical and necessary opportunity to study patient satisfaction when using telemedicine modalities for regular SCD care. The objective of this study was to identify which patient groups rate telemedicine high in satisfaction and usability. Methods: We surveyed 99 patients of the Sickle Cell Clinic for adults at Johns Hopkins who had any form of SCD, were age 18 or above, and participated in at least one video visit between March-July 2020. Telemedicine satisfaction was assessed by the Telemedicine Satisfaction Questionnaire (TSQ), and usability was assessed by the System Usability Scale (SUS). Patients' engagement in their healthcare was assessed by the Patient Activation Measure (PAM13). We conducted linear regression with TSQ and SUS as outcomes and participant characteristics as predictors. Results: Participant characteristics (briefly, mean age 39, 95% African American, 72% female, and 81% with education level above high school) and their association with TSQ and SUS are shown in Table 1. Mean SUS was 72/100 (SD 15), slightly above the defined average usability of 68;mean TSQ was 4.1 (SD 0.5) on a 5-point Likert scale. Participants tended to prefer video visits for their regular care (mean rating of 6.6/10, SD 2.9) but not for management of acute pain (mean rating of 4.9/10, SD 3.2). Participants who preferred video visits for regular SCD care reported higher SUS (p<0.01) and TSQ (p<0.001). We examined the effects of age, sex, income, and education level on TSQ and SUS;higher SUS was associated with an education level above high school (p<0.05), but no other associations were consistently significant. Higher SUS was also associated with having private insurance compared to public insurance (p<0.01) and being employed full-time compared to being unemployed (p<0.05). Disability status was negatively associated with SUS (p<0.05) but not TSQ. PAM13 was associated with higher telemedicine approval as measured by both TSQ and SUS (p<0.01). Conclusions: Our findings suggest that telemedicine has above-average usability and high satisfaction for SCD patients, regardless of age, sex, and income. Patients who were more engaged with their healthcare were more likely to rate telemedicine satisfaction and usability high. Because SUS was negatively associated with disability, lower education level, public insurance, and unemployment, patients within these groups may need more assistance with telemedicine. To improve usability, clinics may consider incorporating support services for patients who have difficulty using telemedicine platforms. Altogether, telemedicine demonstrates promising acceptability to SCD patients across multiple demographic groups and may serve as another method in the toolkit for increasing accessibility to high quality care for these patients. [Formula presented] Disclosures: Lanzkron: Pfizer: Current holder of individual stocks in a privately-held company;Bluebird Bio: Consultancy;Novo Nordisk: Consultancy;GBT: Research Funding;Teva: Current holder of individual stocks in a privately-held company;Shire: Research Funding;CSL Behring: Research Funding;Novartis: Research Funding;Imara: Research Funding.
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Introduction Individuals with Sickle Cell Disease (SCD) require regular, and specialized treatment to manage their health. The COVID-19 pandemic disrupted in person medical visits for all individuals, with a rapid transition to telemedicine to provide medical care. Emerging data shows that the use of telemedicine may provide easier access to care and remove barriers to clinic attendance and improve access to appropriate medical care. Objective The purpose of this study was to use qualitative methods to understand the patients' experiences with telemedicine, identify patient preferences for type of appointment, and possible suggestions to improve telemedicine care. Methods Patients from the Johns Hopkins Sickle Cell Center for Adults who had at least one telemedicine visit were invited to participate in a semi structured interview via zoom meeting or telephone. The interview asked participants about their satisfaction with telemedicine care, barriers to telemedicine, benefits and risks of telemedicine and possible telemedicine improvements. Interviews were recorded, transcribed and coded by two independent raters using thematic analyses to understand the experiences of telemedicine during the COVID-19 pandemic. Results Overall, 30 adults with SCD who had at least one telemedicine visit were invited to participate and completed their interview (mean age 41 years ± xx, 67% female, 93% Black/African American, 3% Multi-Race, 3% Other). “…I can't ignore the convenience of not having to worry about transportation. that there's nothing to stop me from getting there.” During a SCD pain crisis it can it challenging to move and receive treatment as one participant reported “Maybe sometimes I might have pain…then moving around makes it difficult. So, getting in the car and finding somebody to drive you to a hospital or to whatever clinic would be difficult”. Being able to access specialized SCD care even while in pain is important. Having the option of either having telemedicine or in person visits was important to SCD patients “I could treat my crisis here at home. I don't have to go to the emergency room for it. So, if I can see my doctor in the tele-visit appointment and it's going to be constantly every day. And when it's getting worse, then I could go to the emergency room more if needed. If it's not needed, I don't even need to go”. Another emerging theme amongst participants was despite the benefits from telemedicine, they also wanted to continue having in-person visits when they needed. SCD participants felt due to their SCD they still needed to see their doctor in person but it did not have to be for every visit “Well, I think telemedicine, for me, can be used in a setting where there's no such an emergency. Like if I'm having a routine exam, I don't mind having the telemedicine. But if. I'm not feeling well. I don't want to be having a telemedicine”. SCD participants felt they needed a physical exam periodically. “The only thing I didn't like about it was if I'm having some discomfort or some pain. there was no way for the physician to physically examine me”. Along with the lack of physical exam, there were concerns about the lack of vital signs “. the drawbacks would be the lack of the vitals being taken or there's not the personal touch and stuff”. Conclusion The COVID-19 pandemic has presented many obstacles for patients to receive care. People living with SCD found telemedicine to be a positive tool to receive treatment. Patients reported the desire to continue with telemedicine even after the COVID -19 pandemic. Telemedicine allows for more accessibility for a group of individuals who already have numerous barriers to treatment. Future research can seek to identify the impact that telemedicine has on no-show rates, health care utilization, and the impact telemedicine has on patient reported quality of life. Disclosures: Lanzkron: Teva: Current holder of individual stocks in a privately-held company;Shire: Research Funding;GBT: Research Funding;CSL Behring: Research Funding;Novo N rdisk: Consultancy;Bluebird Bio: Consultancy;Pfizer: Current holder of individual stocks in a privately-held company;Imara: Research Funding;Novartis: Research Funding.
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Purpose : COVID-19 and associated mitigation measures have caused unprecedented global disruption. It is not known whether there are disproportionate challenges for persons with a sensory disability. Our cross-sectional study assesses this impact of the pandemic on persons with and without visual or hearing loss. Methods : Experts from diverse disciplines developed a 34-item survey instrument, the Coronavirus Disability Survey, which includes items on general and psychological health, instrumental activities of daily living, isolation, financial and transportation challenges, and information access. The study population included 112 adults with moderate or worse visual impairment (<20/60 in better-seeing eye), 108 with hearing loss (defined using ICD10 codes), and 155 age/sex-matched controls recruited from the University of Michigan (UM) Health System. Survey administration was via email or telephone. The UM IRB approved this study and all participants provided informed consent. Results : Participants reported similarly high levels of disruption of their daily lives with 80% reporting a fair amount or a lot of disruption. Groups reported similar levels of COVID exposure (21%) and infection (45% of exposed). In the visual loss (VL) group, 18% reported a lot of difficulty or being unable to access routine medical care compared with 12% of hearing loss (HL) and 10% of control (C) groups (p=.02). The reasons for increased difficulty with instrumental activities of daily living varied: among those with VL 62% had difficulty due to fear of exposure (54% HI, 45% C);38% said the person assisting them was worried about exposure (6% HI, 7% C);and 12% cited decreased availability of public transportation (2% HI, 3% C). A greater proportion with VL began relying more on family for assistance (31% VI, 7% HI, 13% C) (p<.001 for all comparisons). Among all participants, 30% reported difficulty accessing trusted information about the pandemic;11% of those with VL found the information difficult to see or hear (1% HL, 2% C;p<.001). Conclusions : Individuals with VL may face increased disruption of their daily activities stemming from the pandemic and related mitigation measures, including in accessing healthcare, transportation, and information. Data-driven public health and policy decisions may benefit from a deeper understanding of the differential impact of the pandemic on these vulnerable groups.
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INTRODUCTION: Caring for critically ill children with known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections requires significant changes to usual pediatric intensive care unit operations related to infection control policies and frequent evolution of clinical care practice. We hypothesized that patients with known or suspected SARS-CoV-2 would more often experience delays in timely antibiotic administration. METHODS: We performed a retrospective cohort study including all children with suspected sepsis admitted to our tertiary PICU from March 16 through June 18, 2020. Suspected sepsis was defined by an order for a broadspectrum antibiotic and blood culture. Children with known or suspected SARS-CoV-2 were defined by admission to the Pediatric Special Treatment Unit (PSTU), an isolation unit within the PICU dedicated to care of SARS-CoV-2 patients. The primary outcome of median time to antibiotic administration was compared using the Mann-Whitney-U test. Secondary outcomes included the proportion of antibiotics administered within 1 hour of the order and sepsis pathway utilization. Fisher's exact test was used for comparison of secondary outcomes. RESULTS: A total of 155 sepsis episodes were evaluated, including 14 with known/suspected SARS-CoV-2 and 141 with non-SARS-CoV-2 sepsis. Median time to antibiotic administration was 70.5 minutes in known/suspected SARSCoV- 2 versus 103 minutes in non-SARS-CoV-2 sepsis (NS). Secondary outcomes were also not different between groups. Known/suspected SARS-CoV-2 patients received 36% of new antibiotics within 60 minutes as compared to 46% of non-SARS-CoV-2 patients. Pathway utilization was 29% in known/suspected SARS-CoV-2 and 23% in non-SARSCoV- 2 patients. CONCLUSIONS: Despite significant operational changes enacted to care for SARS-CoV-2 patients, time to antibiotic administration and utilization of the sepsis pathway were no different than in non-SARS-CoV-2 patients with suspected sepsis. Operational challenges may have been overcome by a staffing model that emphasized attending physicians as well as a higher nurse to patient ratio for this population.