Trends in Covid-19 Admissions and Deaths among People with Hiv in South Africa

Background: South Africa experienced five COVID-19 waves and over 90% of the population have developed immunity. HIV prevalence among adults is 19% and over 2 million people have uncontrolled viral loads, posing a risk for poor COVID-19 outcomes. Using national hospital surveillance data, we aimed to investigate trends in admission and factors associated with in-hospital COVID-19 mortality among people with HIV (PWH) in South Africa. Method(s): Data between March 5, 2020 and May 28, 2022 from the national COVID-19 hospital surveillance system, SARS-CoV-2 case linelist and Electronic Vaccine Data System were linked and analysed. A wave was defined as the period for which weekly incidence was >=30 cases/100,000 people. Descriptive statistics were employed for admissions and mortality trends. Postimputation random effect multivariable logistic regression models compared (a) characteristics of PWH and HIV-uninfected individuals, and (b) factors associated with mortality among PWH. Result(s): 68.7% (272,287/396,328) of COVID-19 admissions had a documented HIV status. PWH accounted for 8.4% (22,978/272,287) of total admissions, and 9.8%, 8.0%, 6.8%, 12.2% and 6.7% of admissions in the D614G, Beta, Delta, Omicron BA.1 and Omicron BA.4/BA.5 waves respectively. The case fatality ratio (CFR) among PWH and HIV-uninfected was 24.3% (5,584/22,978) vs 21.7% (54,110/249,309) overall, and in the respective waves was 23.7% vs 20.4% (D614G), 27.9% vs 26.6% (Beta), 26.2% vs 24.5% (Delta), 18.2% vs 9.1% (Omicron BA.1) and 16.8% vs 5.5% (Omicron BA.4/BA.5). Chronic renal disease, malignancy and past TB were more likely, and hypertension and diabetes were less likely in PWH compared to HIV-uninfected individuals. Among PWH, along with older age, male sex and presence of a comorbidity, there was a lower odds of mortality among individuals with prior SARS-CoV-2 infection (aOR 0.6;95% CI 0.4-0.8);>=1 dose vaccination (aOR 0.1;95% CI 0.1-0.1);and those admitted in the Delta (aOR 0.9;95% CI 0.8-0.9), Omicron BA.1 (aOR 0.5;95% CI 0.5-0.6) and Omicron BA.4/BA.5 (aOR 0.5;95% CI 0.4-0.7) waves compared to the D614G wave. PWH with CD4< 200 had higher odds of in-hospital mortality (aOR 1.9;95% CI 1.8-2.1). Conclusion(s): In South Africa, mortality among PWH was less likely in the Delta and Omicron waves but PWH had a disproportionate burden of mortality during the two Omicron waves. Prior immunity protected against mortality, emphasizing the importance of COVID-19 vaccination among PWH, particularly PWH with immunosuppression.

Hyflex for Successful Student Veteran Engineering Education: Say it Like You Mean It

There has been increased attention on producing engineers that are technically proficient while having many professional skills such as organization, time management, communication, and leadership. Across organization types, especially academia, veterans are admired by their peers for their professionalism and communication skills. Student veterans have trained and taken online classes in diverse and remote environments. They are accustomed to learning under ideal and less than ideal circumstances. The combined traits of increased professionalization, prior experience with online learning, and persistence position student veterans to perform as well or better than their traditional college-aged peers during the COVID-19 crisis. In a study of the effectiveness of Hyflex (Hybrid Flexible) learning conducted in the School of Engineering at The Citadel, forced-choice and free text survey responses showed that student veterans match with and differ from traditional college-aged students in important ways. Results from this study can be used to guide best practices in the Hyflex educational model, in order to better serve the student veteran demographic and all students. In particular, student veteran responses coalesce around a focus on effectiveness and time management concerns, as many have families and other external obligations. As a result, student veterans simultaneously want more Hyflex educational options going forward, however they want Hyflex implementation strategies to be refined and executed better in the future with more long-term planning. Active duty and student veterans can serve vital roles in the engineering classroom, modeling appropriate communication strategies for traditional students as well as connecting their global knowledge with the course content, enriching all students' understanding. Faculty and traditional students can benefit from this unique demographic if they are aware of their skills and experiences. This paper presents some of the issues and concerns of active duty and veterans pursuing an engineering degree compared to their traditional student counterparts when institutions pivot to alternative instructional delivery, specifically Hyflex. © American Society for Engineering Education, 2022

We Can't Go Back: Student Perceptions and Remote Learning Protocols

COVID-19 accommodation protocols at The Citadel allowed faculty and students affected by the virus to quickly implement video-based instruction. Extending student access to classroom lecture as recordings on the LMS is just another step toward streaming educational content, as YouTube has made possible for years. Video-based lecture technology also lowers the barriers to education, making connection more physically and financially accessible. After nearly three semesters of implemented video-based teaching protocols in place, students are seeing the value in remote learning contexts when in-person learning is not possible. This paper reports student perceptions of selected effective approaches to hybrid/hyflex learning, comparing student and faculty perceptions regarding its value and effectiveness at a largely residential institution. Faculty who taught remotely during the pandemic underwent continuous professional development at The Citadel in order to ensure successful academic experiences for both faculty and students. Faculty reported feeling significantly burdened with learning about this course delivery mode. Additionally, some faculty struggled with institutional compliance and regionally-approved best practices for instructional design. This paper examines some of the best practices and challenges for building and deploying a set of standards for online instruction, noting that while arduous, high fidelity instructional design creates value for students and faculty, both online and offline, with students appreciating readily accessible course materials and recorded lectures. Best practice recommendations are driven by synthesizing qualitative faculty feedback and Likert-scaled student survey data. Faculty and student survey results show that face-to-face learning is still the 'gold standard' for optimal learning opportunities, however, the pandemic has accelerated the build-out of hyflex course deliveries and created sustainable systems and instructional design standards for online learning. Student perceptions show that they identify and value selected unanticipated benefits to hyflex learning, despite faculty misgivings. This report presents this conflict of perceptions as an opportunity to be seized, and is part of a longer series of studies on student perceptions of learning effectiveness. Validation of results is preliminarily supported by similar protocols adopted at other institutions, and record-setting successes at the Dean, Department Head, and Instructional Design-aid level. Going forward, as the pandemic is brought under control, the authors foresee students' expectations rising: video-recorded lectures and remote connection during live lecture no longer present unsurmountable technological barriers and they aid student learning. © American Society for Engineering Education, 2022.

Using the SWIVL for Effective HyFlex Instruction: Best Practices, Challenges, and Opportunities

Classroom technology and increased student comfort with video instruction through streaming services such as YouTube have created opportunities for enhanced learning in both face-to-face and remote contexts. Working professionals encounter travel and distance-related obstacles that limit access to universities. However, digital technology and distance learning practices lower barriers to education by allowing those who were physically or financially limited to participate. This transition is not automatic-not all degree programs are available online, and some convert more easily to online modalities than others. This paper reports on selected effective approaches for responding to the unplanned pivot from in-person learning to a hybrid/Hyflex learning delivery mode, in the context of a largely residential institution. Our institution's immediate response to Covid-19 at The Citadel was to move all instruction online. Many universities found this approach to be sub-optimal. Recently, some schools, including The Citadel, opted for a Hyflex (Hybrid-Flexible) teaching model for the Fall 2020 return. The Hyflex model ensured that some of the students were in the classroom receiving the instruction in the traditional face-to-face mode (wearing masks and socially distanced), while others livestreamed the lesson and could participate in the lecture through Zoom, depending on their accommodation needs. Unlike purely face-to-face traditional teaching or fully online education, the Hyflex method uses both traditional lecture methods and electronic media to communicate course content to those unable to attend in person. Lecture capture devices are crucial to supporting Hyflex models of instruction. While The Citadel had built out lecture capture classrooms in previous years, scaling these capabilities up under limited time constraints during the rapid shift to online learning was cost-prohibitive. While some universities opted to keep faculty remote, The Citadel reached for a solution that would accommodate all faculty and student needs. Balancing time constraints and existing facility capacity, The Citadel researched and chose to employ the system known as the Swivl (Apple), a robotic lecture capture device that tracks the presenter and facilitates livestreamed interactions with students online. At The Citadel, lessons could also be recorded and posted to the Learning Management Systems (LMS) for students in quarantine or those experiencing poor internet reception during class times. This paper examines some of the best practices and challenges of using the Swivl system for Hyflex delivery of instruction in engineering courses and the success for faculty and students using this technology. Video recordings and delivery mode are tools in the instructional toolbox, just like lectures. Faculty members who are not experts in remote/online instruction may require periodic developmental training to ensure course quality. Instructors need and want to create a course in the preferred mode of face-to-face delivery but know that the current chaos will require all stakeholders to adapt to fully remote learning (synchronous or asynchronous) when required (pandemic or extreme weather event, etc.). © American Society for Engineering Education, 2021

Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in tshwane, south africa.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) first reported in Wuhan, China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponential increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves. METHODS: 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3962 admissions since 4 May 2020, prior to the Omicron outbreak. Ninety-eight patient records at peak bed occupancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths, hospital admissions and excess deaths data were sourced from the National Institute for Communicable Diseases, the National Department of Health and the South African Medical Research Council. RESULTS: For the Omicron and previous waves, deaths and ICU admissions were 4.5% vs 21.3% (p<0.00001), and 1% vs 4.3% (p<0.00001) respectively; length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49,8 years. Admissions in the Omicron wave peaked and declined rapidly with peak bed occupancy at 51% of the highest previous peak during the Delta wave. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 28% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards required oxygen supplementation compared to 99.5% in the first wave. The death rate in the face of an exponential increase in cases during the Omicron wave at the city and provincial levels shows a decoupling of cases and deaths compared to previous waves, corroborating the clinical findings of decreased severity of disease seen in patients admitted to the Steve Biko Academic Hospital. CONCLUSION: There was decreased severity of COVID-19 disease in the Omicron-driven fourth wave in the City of Tshwane, its first global epicentre.

Report of a Powered Air-Purifying Respirator and Its Use in the Dental Setting

BACKGROUND: Respirators have received much attention since the outbreak of the COVID-19 pandemic. Due to a substantial shortage of the most commonly used respirator, the N95 Filtering Facepiece Respirator (N95), as well as the desire to have added protection while performing aerosol generating procedures (AGPs), dental healthcare personnel (DHCP) have considered alternative respirator options. It is well documented in the medical literature that the Powered Air-Purifying Respirator (PAPR) provides better protection against respiratory pathogens;however, there are no reported cases that describe the use of PAPRs in the dental setting. This survey report evaluates the use of a loose-fitting full facepiece PAPR by different dental providers. OBJECTIVE: To determine if a PAPR can be used in the dental setting and identify any potential barriers to use. METHODS: Eleven DHCP representing general dentistry, dental hygiene, pediatric dentistry, endodontics, orthodontics, oral and maxillofacial surgery and maxillofacial prosthodontics at Walter Reed National Military Medical Center (WRNMMC) and Naval Postgraduate Dental School (NPDS) were asked to wear the MAXAIR PAPR while performing an AGP. They then completed a 14-question survey. RESULTS: There was a 100% response rate. All DHCP with the exception of the endodontist were able to successfully wear the MAXAIR PAPR for the duration of their procedure. All DHCP reported that the PAPR was more comfortable than expected. There were no reports of fogging or hindrance to visibility, breathing was unaffected or enhanced, and the noise level was tolerable. Average time to don and doff the PAPR was 5 minutes. All DHCP were able to wear loupes;some were not able to wear a headlight. Two DHCP reported a history of mild claustrophobia, and both were able to tolerate the PAPR without any issue. 44% preferred the PAPR over the N95. CONCLUSION: This preliminary survey of a loose-fitting PAPR in the dental setting suggests there is a place for PAPRs in the dental community.