Establishing SARS-CoV-2 Membrane protein-specific antibodies as a valuable serological target via high-content microscopy

The prevalence and strength of serological responses mounted towards SARS-CoV-2 proteins other than nucleocapsid (N) and spike (S), which may be of use as additional serological markers, remains underexplored. Using high content microscopy to assess antibody responses against full length StrepTagged SARS-CoV-2 proteins, we found that 85% (166/196) of unvaccinated individuals with RT-PCR confirmed SARS-CoV-2 infections and 74% (31/42) of individuals infected after being vaccinated developed detectable IgG against the structural protein M, which is higher than previous estimates. Compared with N antibodies, M IgG displayed a shallower time-dependent decay and greater specificity. Sensitivity for SARS-CoV-2 seroprevalence was enhanced when N and M IgG detection was combined. These findings indicate that screening for M seroconversion may be a good approach for detecting additional vaccine breakthrough infections and highlight the potential to use HCM as a rapidly deployable method to identify the most immunogenic targets of newly emergent pathogens. Graphical

Decay of enveloped SARS-CoV-2 and non-enveloped PMMoV RNA in raw sewage from university dormitories.

Introduction: Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA has been frequently detected in sewage from many university dormitories to inform public health decisions during the COVID-19 pandemic, a clear understanding of SARS-CoV-2 RNA persistence in site-specific raw sewage is still lacking. To investigate the SARS-CoV-2 RNA persistence, a field trial was conducted in the University of Tennessee dormitories raw sewage, similar to municipal wastewater. Methods: The decay of enveloped SARS-CoV-2 RNA and non-enveloped Pepper mild mottle virus (PMMoV) RNA was investigated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) in raw sewage at 4°C and 20°C. Results: Temperature, followed by the concentration level of SARS-CoV-2 RNA, was the most significant factors that influenced the first-order decay rate constants (k) of SARS-CoV-2 RNA. The mean k values of SARS-CoV-2 RNA were 0.094 day-1 at 4°C and 0.261 day-1 at 20°C. At high-, medium-, and low-concentration levels of SARS-CoV-2 RNA, the mean k values were 0.367, 0.169, and 0.091 day-1, respectively. Furthermore, there was a statistical difference between the decay of enveloped SARS-CoV-2 and non-enveloped PMMoV RNA at different temperature conditions. Discussion: The first decay rates for both temperatures were statistically comparable for SARS-CoV-2 RNA, which showed sensitivity to elevated temperatures but not for PMMoV RNA. This study provides evidence for the persistence of viral RNA in site-specific raw sewage at different temperature conditions and concentration levels.

Use of Epidemiology Surge Support to Enhance Robustness and Expand Capacity of SARS-CoV-2 Pandemic Response, South Africa.

As COVID-19 cases increased during the first weeks of the pandemic in South Africa, the National Institute of Communicable Diseases requested assistance with epidemiologic and surveillance expertise from the US Centers for Disease Control and Prevention South Africa. By leveraging its existing relationship with the National Institute of Communicable Diseases for >2 months, the US Centers for Disease Control and Prevention South Africa supported data capture and file organization, data quality reviews, data analytics, laboratory strengthening, and the development and review of COVID-19 guidance This case study provides an account of the resources and the technical, logistical, and organizational capacity leveraged to support a rapid response to the COVID-19 pandemic in South Africa.

Evaluating the Comparative Accuracy of COVID-19 Mortality Forecasts: An Analysis of the First-Wave Mortality Forecasts in the United States

The sudden onset of the COVID-19 pandemic posed significant challenges for forecasting professionals worldwide. This article examines the early forecasts of COVID-19 transmission, using the context of the United States, one of the early epicenters of the crisis. The article compares the relative accuracy of selected models from two forecasters who informed government policy in the first three months of the pandemic, the Institute of Health Metrics and Evaluation (IHME) and Columbia University. Furthermore, we examine whether the forecasts improved as more data became available in the subsequent months of the pandemic, using the forecasts from Los Alamos National Laboratory and the University of Texas, Austin. The analysis focuses on mortality estimates and compares forecasts using epidemiological and curve-fitting models during the first wave of the pandemic from March 2020 to October 2020. As health agencies worldwide struggled with uncertainty in models and projections of COVID-19 caseload and mortality, this article provides important insights that can be useful for crafting policy responses to the ongoing pandemic and future outbreaks.

Development of a respiratory quality improvement faculty in an acute hospital using QI methodology.

National Health Service (NHS) clinical staff are required to demonstrate involvement in quality improvement (QI) and patient safety. Clinicians are often best placed to identify problems and design solutions for their own clinical environments, yet the rotational nature of training can impact on the design, implementation and sustainability of projects.The In-hospital Quality Improvement for Respiratory team was created in August 2020 within a busy respiratory department to inspire a culture of continuous improvement and provide a sustainable infrastructure to support and progress QI projects (QIPs).The trust uses the LifeQI platform which provides a change score from 0.5 (intention to participate) to 5.0 (outstanding sustainable results) as a representation of a QIP's progress.We aimed to increase the number of QIPs in the respiratory department registered on the LifeQI platform from 1 to at least 10 projects by September 2021.A QI framework was used to identify and address four primary improvement drivers: (1) QI understanding/training, (2) QI faculty communication, (3) QI participation, and (4) QIP completion using multiple Plan-Do-Study-Act cycles. Data were collected on the number of active respiratory projects registered within the LifeQI platform, mean LifeQI change score and the number of projects with a change score ≤1.Twenty-four new QIPs were initiated in the first 12 months, with a number of projects leading to sustainable change. The largest improvements were seen in autumn 2020 as the faculty's multidisciplinary membership expanded.We achieved our aim of increasing the number of registered QIPs, sustaining the QI faculty throughout the COVID-19 pandemic. Our multidisciplinary membership continues to increase and the faculty has improved access, organisation and project progression across a large department with an established process for rotating staff to join existing QIPs. Our model has the potential to be replicated in other clinical departments within NHS organisations.

Impact of COVID-19 on Admissions and Outcomes for Children With Complex Chronic Conditions.

BACKGROUND: Although pediatric health care use declined during the coronavirus disease 2019 (COVID-19) pandemic, the impact on children with complex chronic conditions (CCCs) has not been well reported. OBJECTIVE: To describe the impact of the pandemic on inpatient use and outcomes for children with CCCs. METHODS: This multicenter cross-sectional study used data from the Pediatric Health Information System. We examined trends in admissions between January 2020 through March 2021, comparing them to the same timeframe in the previous 3 years (pre-COVID-19). We used generalized linear mixed models to examine the association of the COVID-19 period and outcomes for children with CCCs presenting between March 16, 2020 to March 15, 2021 (COVID-19 period) to the same timeframe in the previous 3 years (pre-COVID-19). RESULTS: Children with CCCs experienced a 19.5% overall decline in admissions during the COVID-19 pandemic. Declines began in the second week of March of 2020, reaching a nadir in early April 2020. Changes in admissions varied over time and by admission indication. Children with CCCs hospitalized for pneumonia and bronchiolitis experienced overall declines in admissions of 49.7% to 57.7%, whereas children with CCCs hospitalized for diabetes experienced overall increases in admissions of 21.2%. Total and index length of stay, costs, and ICU use, although statistically higher during the COVID-19 period, were similar overall to the pre-COVID-19 period. CONCLUSIONS: Total admissions for children with CCCs declined nearly 20% during the pandemic. Among prevalent conditions, the greatest declines were observed for children with CCCs hospitalized with respiratory illnesses. Despite declines in admissions, overall hospital-level outcomes remained similar.

Inpatient Use and Outcomes at Children's Hospitals During the Early COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care use, including decreased emergency department visits for children. In this study, we sought to describe the impact of the COVID-19 pandemic on inpatient use within children's hospitals. METHODS: We performed a retrospective study using the Pediatric Health Information System. We compared inpatient use and clinical outcomes for children 0 to 18 years of age during the COVID-19 period (March 15 to August 29, 2020) to the same time frame in the previous 3 years (pre-COVID-19 period). Adjusted generalized linear mixed models were used to examine the association of the pandemic period with inpatient use. We assessed trends overall and for a subgroup of 15 medical All Patient Refined Diagnosis Related Groups (APR-DRGs). RESULTS: We identified 424 856 hospitalizations (mean: 141 619 hospitalizations per year) in the pre-COVID-19 period and 91 532 in the COVID-19 period. Compared with the median number of hospitalizations in the pre-COVID-19 period, we observed declines in hospitalizations overall (35.1%), and by APR-DRG (range: 8.5%-81.3%) with asthma (81.3%), bronchiolitis (80.1%), and pneumonia (71.4%) experiencing the greatest declines. Overall readmission rates were lower during the COVID-19 period; however, other outcomes, including length of stay, cost, ICU use, and mortality remained similar to the pre-COVID-19 period with some variability by APR-DRGs. CONCLUSIONS: US children's hospitals observed substantial reductions in inpatient admissions with largely unchanged hospital-level outcomes during the COVID-19 pandemic. Although the impact on use varied by condition, the most notable declines were related to inpatient admissions for respiratory conditions, including asthma, bronchiolitis, and pneumonia.

"Re-placed" - Reconsidering relationships with place and lessons from a pandemic.

The Covid-19 pandemic has prompted a reconsideration, perhaps even a fundamental shift in our relationships with place. As people worldwide have experienced 'lockdown,' we find ourselves emplaced in new and complex ways. In this Commentary, we draw attention to the re-working of people-place relations that the pandemic has catalysed thus far. We offer insights and suggestions for future interdisciplinary research, informed by our diverse positionalities as researchers based in different continents employing diverse approaches to people-place research. The article is structured in two sections. First, we consider theoretical aspects of our current relationships to place by proposing a framework of three interdependent axes: emplacement-displacement, inside-outside, and fixity-flow. Second, we identify six implications of these dialectics: for un-making and re-making 'home'; precarity, exclusion and non-normative experiences of place; a new politics of public space; health, wellbeing and access to 'outside' recreational spaces; re-sensing place, virtual escapes and fluid places, and methodological and ethical considerations. Across these topics, we identify 15 key questions to guide future research. We conclude by asserting that learning lessons from the global pandemic is necessarily tentative, requiring careful observation of altered life circumstances, and will be deficient without taking relationships with place into account.