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Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023
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Background and Aims: While insulin pump training has historically been conducted in person, the COVID-19 pandemic has necessitated a rise in virtual alternatives. The present study aims to examine the perceived effectiveness of in-person versus online pump training among people with diabetes in Europe. Method(s): From April-May 2022, 2,457 people with type 1 diabetes in France, Germany, Italy, Netherlands, Sweden, and UK took an online survey in which they indicated their use of pump therapy. Respondents who started using a new pump model in the last year indicated their pump training method (n = 366) and those who received training reported their confidence in pump use after training (n = 356). Confidence scores were calculated as the proportion of users selecting 9 or 10 on a 10-point scale. Result(s): The majority of pump users trained in person with an HCP or pump company representative (76%). One quarter of pump users trained virtually with a professional (24%), and 12% completed a self-guided training tutorial online. Those who completed a self-guided tutorial were significantly less confident using their pump than those who trained with a professional in person (34% vs. 51%, p = 0.021) or virtually (34% vs. 55%, p = 0.006). No differences in confidence were observed between those who trained with a professional in person or virtually (51% vs. 55%). Conclusion(s): These findings suggest that virtual training may be an effective alternative to in-person methods, though professional guidance is critical to building confidence in pump use. Further research is needed to identify improvements to online, self-led trainings to increase proficiency among new pump users.
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COVID-19 , SARS-CoV-2 , Humans , COVID-19/diagnosis , Tissue Donors , Lung/diagnostic imaging , Blood Donors , Antibodies, ViralABSTRACT
Rationale: Current guidelines recommend peanut introduction to high-risk infants. However, compliance and rates of new peanut allergy (PA) require further study. Methods: Participants aged 4-11 months with no prior peanut exposure and (i) diagnosis of non-peanut food allergy, (ii) moderate-severe atopic dermatitis, or (iii) first degree relative with PA were enrolled. PA status was determined by skin testing and food challenge. Participants without PA were advised to consume 2 grams of peanut protein three times/week. Monthly questionnaires were administered, with follow-up visits at 18 and 30 months. Results: At baseline, 35/326 (11%) participants were peanut allergic. Of 291 without PA, 78 (27%) discontinued peanut at least temporarily 115 times during follow-up because of suspected participant reaction (40%), fear of reaction (3%), reaction or fear of reaction in a family member (21%), participant refusal (9%), peanut introduction was too much work (3%), or other reasons (23%), including the COVID-19 pandemic. Six of 291 participants (2.1%) who consumed peanut developed PA (2 consistent with FPIES). Among 291 participants without PA at baseline, none of the 17 participants with initial skin prick test of at least 4 mm and <10 mm developed PA. Conclusions: New PA after early introduction recommendations was rare, confirming the LEAP study findings. Transient discontinuation was common, mostly due to suspected participant reaction. High-risk children may require substantial support to keep peanut in their diet.
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BACKGROUND: Decisions to transplant organs from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test-positive (NAT+) donors must balance risk of donor-derived transmission events (DDTE) with the scarcity of available organs. METHODS: Organ Procurement and Transplantation Network (OPTN) data were used to compare organ utilization and recipient outcomes between SARS-CoV-2 NAT+ and NAT- donors. NAT+ was defined by either a positive upper or lower respiratory tract (LRT) sample within 21 days of procurement. Potential DDTE were adjudicated by OPTN Disease Transmission Advisory Committee. RESULTS: From May 27, 2021 (date of OTPN policy for required LRT testing of lung donors) to January 31, 2022, organs were recovered from 617 NAT+ donors from all OPTN regions and 53 of 57 (93%) organ procurement organizations. NAT+ donors were younger and had higher organ quality scores for kidney and liver. Organ utilization was lower for NAT+ donors compared to NAT- donors. A total of 1241 organs (776 kidneys, 316 livers, 106 hearts, 22 lungs, and 21 other) were transplanted from 514 NAT+ donors compared to 21 946 organs from 8853 NAT- donors. Medical urgency was lower for recipients of NAT+ liver and heart transplants. The median waitlist time was longer for liver recipients of NAT+ donors. The match run sequence number for final acceptor was higher for NAT+ donors for all organ types. Outcomes for hospital length of stay, 30-day mortality, and 30-day graft loss were similar for all organ types. No SARS-CoV-2 DDTE occurred in this interval. CONCLUSIONS: Transplantation of SARS-CoV-2 NAT+ donor organs appears safe for short-term outcomes of death and graft loss and ameliorates the organ shortage. Further study is required to assure comparable longer term outcomes.
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COVID-19 , Nucleic Acids , Organ Transplantation , Tissue and Organ Procurement , Humans , SARS-CoV-2 , Advisory Committees , Tissue DonorsABSTRACT
Objectives: During the COVID-19 pandemic, university faculty experienced an emergency pivot to online instruction in the Spring 2020 semester. Many had no prior online teaching experience and were given little time to adapt. This study examines pre-pandemic online teaching experience and training strategies used to learn how to teach online during the emergency remote teaching semester, perceptions of change in online teaching ability and the pandemic’s impact on teaching effectiveness, and interest in future online teaching opportunities. Method: Full-time faculty (n = 455) from four public regional universities in the southern United States completed a survey at the start of the Fall 2020 semester. Results: Over 35% had no prior online teaching experience, while 43% had taught several online courses. During the pandemic, in an effort to learn or improve online teaching skills, 13.4% sought peer mentoring, 31.9% completed a training program, and 34.9% both sought mentoring and completed training. Perceived online teaching skills, impact of the pandemic on teaching effectiveness, and interest in future online teaching were significantly related to prior online teaching experience and training sought. Conclusions: Faculty with less online experience perceived a greater negative effect of the pandemic on teaching performance and had less interest in future online teaching. Both mentoring and training enhanced perceived teaching skills, lowered the negative impact of the pandemic on teaching effectiveness, and promoted a positive attitude about future online teaching. Implications for Theory or Practice: The results provide support for the importance of faculty development programs in shaping attitudes and perceived effectiveness in online teaching and add to existent research on university faculty during the pandemic. Evidence from studies such as this provides universities with data that may be used to re-evaluate induction and training to improve instructional delivery in future instances when emergency remote teaching is required. © The Author(s)
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RATIONALE: Around 4.6 million people in the United Kingdom (UK) have asthma, with an estimated 5.7% treated for severe asthma. Benralizumab is indicated for the treatment of severe eosinophilic asthma (SEA) in adults inadequately controlled despite appropriate maintenance therapy. The Connect 360 Patient Support Programme (PSP) for patients on benralizumab includes options for home-based drug administration, education and adherence support by trained nurses - of particular relevance during the COVID-19 pandemic. Limited evidence exists on the benefit of PSPs for asthma patients or those administering biological therapies at home. This study aims to describe patient characteristics, key outcomes and experience with the PSP using UK data from Connect 360. METHODS: A non-interventional, retrospective cohort study of patients, enrolled in the PSP (Oct-2019 onwards) and consenting to the use of personal data for research purposes (“study cohort”). Patients opting for additional support services with at least one nurse interaction within described study timeframes formed the clinical cohort. Patients were observed up to 48 weeks post-PSP enrolment (interim data taken on 31-Mar-2021;data collection ongoing) with study endpoints assessed at baseline (0-4 weeks), 24 (±4) weeks and 48 (±8) weeks post-PSP enrolment. Characteristics at enrolment are described for the study cohort. Patient-reported clinical outcomes (hospitalisations, maintenance oral corticosteroid [mOCS] use, Asthma Control Questionnaire [ACQ-6] scores) and service satisfaction (1-5 point scale, 5 being most satisfied) were analysed where available from routine PSP nurse calls/visits. Analysis was descriptive;Kaplan-Meier estimators were used to estimate PSP discontinuation rates. RESULTS: The study cohort was 611 patients (mean enrolment age: 54.1 years, 63.2% female [N=323]). Most (98.9%) were benralizumab users on maintenance dosing (8-weekly) at enrolment. The clinical cohort consisted of 149 (baseline), 175 (24 weeks) and 195 (48 weeks) patients. PSP discontinuation rates were 4.4% and 11.6% at 24 and 48 weeks. Proportion of patients reporting mOCS use was 49.7%, 44.0% and 32.8% at each timepoint and hospitalizations were 10.9% and 4.1% at 24 and 48 weeks. Mean ACQ-6 scores decreased over time. Mean (SD) satisfaction scores were 4.6 (0.7) and 4.8 (0.5) at 24 and 48 weeks, respectively. (Table 1). CONCLUSIONS: Overall patients' experience with the PSP was positive, evidenced by high satisfaction with and persistence to the PSP. Where data were available, proportion of patients reporting mOCS and hospitalizations at 48 weeks were numerically lower than previous timepoints and mean ACQ-6 scores improved, suggesting a positive impact of benralizumab treatment within the PSP.
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Background and Aims: Diabetes is one of the most financially burdensome diseases in the U.S., and the COVID-19 pandemic has exacerbated financial stress among people with diabetes (PWD). This study investigated how finances have impacted diabetes care from June 2020 to June 2021. Methods: In June 2021, 4,780 adults living with diabetes in the U.S. completed an online survey in which they reported the influence of finances on their diabetes care on a scale of 1 to 5 and whether they delayed medical care due to cost in the last year. Respondents who reported delaying their medical care due to cost (n = 759) were asked in which ways they delayed care. Results: Finances have a significant influence on diabetes care for 24% of respondents. In the last year, 13% of PWD delayed care due to cost, and those in lower income brackets were more likely to delay care. Among those who delayed care, 48% of CGM users delayed ordering CGM supplies and 30% of CGM users delayed starting on a new diabetes device. Half of respondents using a pump delayed ordering pump supplies. Among those on MDI, 50% delayed an insulin refill compared to 38% of respondents using a pump. Conclusions: At a time when high costs of care are intersecting with pandemic-related financial stress, PWD are postponing care and delaying orders of necessary supplies, which may lead to further health complications. COVID-19 has amplified the need for policy and industry to take action to ensure PWD can access the care and supplies they need to live.
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Responding to the COVID-19 pandemic has created unprecedented social and political challenges. Mitigation strategies often disrupt the daily lives of citizens and constrain rights and privileges. Policies intended to contain disease spread have provoked resentment, resistance, and backlash. We examine the extent to which specific COVID-19 policy responses influence the frequency of civil unrest. Combining insights from both grievance and opportunity models of dissent, we contend that pandemic-response policies are most likely to lead to unrest when the grievances and opportunities created by disease-mitigation strategies reinforce each other. We test our arguments with nuanced information on specific pandemic-mitigation policies, combined with geolocated events data on COVID-19-related social unrest activities. We find that policies such as workplace and school closures, which induce intense grievances and reduce the opportunity cost of engaging in collective mobilization, are associated with increases in dissent activities. Policies that restrict opportunities for mobilization, such as restrictions on public transportation, reduce the number of dissent activities. Notably, economic support policies attenuate the effects of workplace closures on dissent. Our results illustrate the varying effects of pandemic-mitigation policies on unrest depending on how the grievances they inspire relate to the opportunity they create.
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Objective: The rapid rise of telemedicine, necessitated by the COVID-19 pandemic, has changed how care is administered and created additional burdens for healthcare professionals. This study investigated how Diabetes Care and Education Specialists (DCES) have implemented telemedicine in their practices to identify possible areas for improvement. Method: 350 DCES from an opted-in US research panel were surveyed. Respondents were asked about their expected and present use of telemedicine, satisfaction with telemedicine versus in-person appointments, and perceived changes in the frequency of treatment decisions made over telemedicine compared to in-person. Result: On average, respondents reported that 57% of appointments were conducted using telemedicine this year and estimated a decrease in telemedicine use during 2021 (41%). While 67% of respondents were satisfied with in-person visits (selecting a 9 or 10 on a 10-point scale), just 25% were satisfied with telemedicine visits. Analysis of verbatim comments revealed dissatisfaction with telemedicine stems from difficulty with teaching patients virtually (20%), technology use (18%), establishing personal connections with patients (16%), and obtaining patient device data (11%). DCES indicated that larger treatment decisions like starting new therapies/devices occur less often over telemedicine whereas adjusting patient's settings occurs more often. For example, relative to in-person visits, 64% report starting patients on new insulin pumps less often while 62% report adjusting pump settings just as often. Conclusion: Telemedicine has become a regular part of DCES's practices despite notable gaps in satisfaction and ability to make certain treatment decisions when compared with in-person visits. Although telemedicine may be a useful tool for adjusting doses and device settings, these findings emphasize the need for improvements surrounding virtual diabetes care to alleviate the challenges experienced by providers.
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Background Maintaining high levels of immunisation uptake is vital to protect children from vaccine-preventable disease. The COVID-19 pandemic and measures taken to control it, including national lockdowns, threatened to disrupt routine immunisation programmes. Initial reports from the early weeks of lockdowns in the UK and worldwide suggested that preschool immunisation uptake was falling. In Scotland enhanced surveillance databases were set up to monitor and rapidly assess the impact on childhood immunisation uptake rates. Objectives This aim of this study was to evaluate the impact on timely childhood immunisation uptake (defined as within 4 weeks of becoming eligible for the immunisation according to the national immunisation schedule) before, during and after a national lockdown using data from the entire Scottish population. Methods This was an observational study using routinely collected data in the year prior to the pandemic (2019), immediately before (January -22 March 2020), during (22 March-31 July 2020) and after (August-September 2020) the first period of the UK 'lockdown'. Data were obtained for Scotland from the Public Health Scotland 'COVID19 wider impacts on the health care system' dashboard (https://scotland.shinyapps.io/ phs-covid-wider-impact/). Uptake of the three doses of DTaP/ IPV/Hib/HepB vaccine in early infancy and two doses of MMR at age 12 months and 3 years 4 months was evaluated at the four time points. Timely uptake rates were compared using binary logistical regression analysis. Data were also analysed separately by geographical region and indices of deprivation. Results Vaccination rates in Scotland for all the childhood immunisations rose during lockdown compared to the previous year (table 1). Significant increases in uptake were seen across all deprivation level, though there was evidence of greater improvement for the least deprived for the MMR immunisations. Conclusions This study demonstrates that the national lockdown in Scotland has had a positive effect on timely preschool immunisation uptake. This provides an excellent opportunity to explore the reasons behind this increase, whether this has been achieved through the removal of barriers, increased motivation or awareness campaigns including those co-ordinated by the Scottish Immunisation programme and sharing of best practice. Promoting immunisation uptake and addressing potential vaccine hesitancy is particularly important in the context of ongoing and repeated lockdownstyle control measures and with future of a paediatric COVID-19 vaccination campaigns.
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Introduction: Healthcare worker adherence to proper Hand Hygiene (HH) practices and access to alcohol-based hand-rub (ABHR) remains limited in many low-resource settings. An effective HH improvement strategy is a critical element of infection prevention and control (IPC) programmes, as seen in the ongoing COVID-19 pandemic. The project PASQUALE aimed to establish the WHO multimodal HH strategy at the University Hospital Bouaké, Côte d'Ivoire. Objectives: The project PASQUALE aimed to establish the WHO multimodal HH strategy at the University Hospital Bouaké, Côte d'Ivoire. Methods: The improvement of HH knowledge and HH compliance was assessed in a before-and-after intervention study. The intervention consisted of a HH training for staff of all departments regardless of their participation in the initial assessment and the introduction of local production of ABHR. Assessment of HH knowledge and compliance was performed 12 months before (06/2018), right after the intervention (10/2019) and at a ten months interval (08/2020), whereby knowledge was assessed through a self-administered questionnaire and HH compliance through direct observations. Results: Baseline knowledge score was 14/25, increased significantly to 17/25 upon the first and decreased to 13/25 in the second assessment. HH compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. An average of 74.4L ABHR per month were produced from 07/2019 until 03/2020, when the first COVID-19 infection was confirmed in Côte d'Ivoire, and 138L per month from 04/2020 onwards. Monthly consumption of ABHR in the same time increased from 76 to 125L. Conclusion: The implementation of the WHO HH improvement strategy led to sustained improvements in HH compliance without relying on costly interventions. This study emphasized that the implementation of the strategy is feasible and has effectively contributed to the IPC response during the COVID-19 pandemic.
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Introduction: In response to the COVID-19 pandemic, the WHO launched a strategic preparedness and response plan, outlining public health measures to support countries worldwide. Objectives: Our study aimed to assess the level of preparedness of health care workers (HCWs) towards COVID-19 and strenghten HCWs knowledge and perception of the SARS-COV-2 pandemic and its related Infection prevention and control (IPC) measures in Faranah, Guinea. Methods: We conducted a cross-sectional pre- and post-intervention study between april 2020 and march 2021. This consisted of a baseline assessment, in-person training, an immediate post-training follow-up and a three months follow-up. Participants were HCWs from the Faranah Regional Hospital (HRF) and two health care centres (HCC). The assessment was carried-out using a questionnaire developed based on WHO recommendations. Data was analysed using STATA Version 17. Results: There was no significant difference in the overall mean knowledge score during baseline (32.67 ± 5.81) and second follow-up (33.96 ± 4.04 p < 0.467). Subgroup analysis found significant improvement in knowledge for the HCC, but not for the hospital, comparing baseline (29.35 ± 6.89) and second follow-up (34.38 ± 3.89, p < 0.007). Overall, there was significant improvement in knowledge among Auxiliary Nurses in the HCC (baseline 28.21 ± 6.68, follow-up 33.87 ± 4.26 p < 0.010), while no significant improvement was observed in other profession groups in both HRF and HCC. Assessment of perception towards Covid-19 pandemic revealed that 48.6% of participants responded feeling helpless regarding the pandemic at baseline, while only 12.9% responded this way after second follow-up. Conclusion: The study highlighted optimal level of preparedness towards COVID-19 and its IPC measures among HCWs in both HRF and HCC as reflected by the good knowledge score noted in both baseline and follow-ups. Knowledge was further strengthened in the HCC-relatively low resourced facilities as compared to HRF, as shown by improvement in knowledge after training. Furthermore, IPC training was a key component in improving certain perceptions HCW's had towards COVID-19.
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Introduction: The Multimodal WHO Hand Hygiene (HH) Strategy is a widely used and well recognized approach. However, the evidence on the sustainability in low-resource settings is still scarce. The WHO strategy was implemented at the Regional Hospital of Faranah (HRF), but context specific challenges developed. Objectives: We aimed to promote HH culture by addressing these challenges and implementing appropriate solutions. Methods: Over a period of 3 years, the project team used quantitative and qualitative methods to assess HH improvement. Local staff was trained and instructed to track the development, identify barriers and find solutions to build a sustained HH culture. Results: Four main barriers were identified and addressed by targeted measures. 1) The lack of staff for local production was overcome by implementing a train the trainer approach. The initially trained pharmacist trained four other team members. To further strengthen the production team, a national solution of training and sending staff is proposed by the HRF. 2) Difficulties in obtaining production ingredients in high quality were addressed by purchasing large quantities and the establishment of a storage room in the hospital pharmacy. 3) To prepare for sustainable local production, the return, recycling and exchange of empty bottles was planned by opening a register of distribution. 4) To stop the decrease in knowledge and compliance over time, a HH championship every 6 months was initiated. All hospital departments were invited to participate and staff assessed via the WHO knowledge questionnaires and HH observations. Furthermore, refresher trainings and demonstrations of HH were given in daily staff meetings. Conclusion: To build HH culture is feasible in low-resource hospitals such as the HRF. However, context specific challenges require locally designed solutions such as the introduction of recycling systems for ABHR bottles, organizing HH championships, or promoting daily staff trainings to maintain the improvement on HH practises and creating a HH culture. This development of a HH culture and its sustainable local production helped the HRF to respond to the current COVID-19 pandemic.
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OBJECTIVES: This study aimed to determine SARS-CoV-2 seroprevalence among pregnant women in the Scottish population during the second wave of the COVID-19 pandemic. STUDY DESIGN: Prospective national serosurvey. METHODS: We tested 13,428 residual samples retrieved from pregnant women participating in the first trimester combined ultrasound and biochemical screening for fetal trisomy across Scotland for SARS-CoV-2 antibodies over a 6-month period from November 2020 to April 2021. Seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. RESULTS: Seroprevalence rates in the antenatal samples significantly increased from 5.5% (95% confidence interval [CI] 4.7%-6.5%) in the 5-week period up to and including International Organization for Standardization (ISO) Week 51 (w/b Monday 14 December 2020) to 11.3% (95% CI 10.1%-12.6%) in the 5-week period up to and including ISO Week 14 (w/b Monday 5 April 2021). Increasing seroprevalence trends across the second wave were observed among all age groups. CONCLUSIONS: By the end of the second wave of the COVID-19 pandemic, approximately one in 10 women tested around the end of the first trimester of pregnancy had antibodies to SARS-CoV-2, suggesting that the vast majority were still susceptible to COVID-19 as they progressed to the later stages of pregnancy, when risks from infection are elevated for both mother and baby.
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COVID-19 , SARS-CoV-2 , Antibodies, Viral , Female , Humans , Immunoglobulin G , Pandemics , Pregnancy , Pregnant Women , Prevalence , Prospective Studies , Scotland/epidemiology , Seroepidemiologic StudiesABSTRACT
Without timely assessments of the number of COVID-19 cases requiring hospitalisation, healthcare providers will struggle to ensure an appropriate number of beds are made available. Too few could cause excess deaths while too many could result in additional waits for elective treatment. As well as supporting capacity considerations, reliably projecting future "waves" is important to inform the nature, timing and magnitude of any localised restrictions to reduce transmission. In making the case for locally owned and locally configurable models, this paper details the approach taken by one major healthcare system in founding a multi-disciplinary "Scenario Review Working Group", comprising commissioners, public health officials and academic epidemiologists. The role of this group, which met weekly during the pandemic, was to define and maintain an evolving library of plausible scenarios to underpin projections obtained through an SEIR-based compartmental model. Outputs have informed decision-making at the system's major incident Bronze, Silver and Gold Commands. This paper presents illustrated examples of use and offers practical considerations for other healthcare systems that may benefit from such a framework.
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During the first wave of the COVID-19 pandemic it emerged that the nature and magnitude of demand for mental health services was changing. Considerable increases were expected to follow initial lulls as treatment was sought for new and existing conditions following relaxation of 'lockdown' measures. For this to be managed by the various services that constitute a mental health system, it would be necessary to complement such projections with assessments of capacity, in order to understand the propagation of demand and the value of any consequent mitigations. This paper provides an account of exploratory modelling undertaken within a major UK healthcare system during the first wave of the pandemic, when actionable insights were in short supply and decisions were made under much uncertainty. In understanding the impact on post-lockdown operational performance, the objective was to evaluate the efficacy of two considered interventions against a baseline 'do nothing' scenario. In doing so, a versatile and purpose-built discrete time simulation model was developed, calibrated and used by a multi-disciplinary project working group. The solution, representing a multi-node, multi-server queueing network with reneging, is implemented in open-source software and is freely and publicly available.
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Francisella tularensis is a virulent bacterium which hijacks the host's immune response, turning cells usually tasked with killing foreign organisms as nutrient-rich receptacles for rapid multiplication. It is designated a Tier 1 Select Agent by the US CDC due to its potential to cause widespread mortality upon deliberate release. In this study, the key biological mechanisms of host infection are modelled as a continuous-time Markov chain (CTMC) and solved via discrete event simulation (DES). The efficacy of various medication strategies at the behest of public health authorities are investigated. Without treatment, the median lethal dose - not previously considered in humans - is estimated at approximately 1,000 organisms. Results suggest that fatality can be averted if antibiotics are administered for at least 7 days, no later than 10 days post exposure. In a mass casualty setting, this can reduce symptomatic cases by 18% from the baseline involving no medication. Reductions of 59% are possible if medication can be disseminated no later than 5 days post exposure, mitigating otherwise severe pressure on healthcare services. Novel use of CTMC and DES highlight the potential for OR in the field of immunology, where further opportunities may present in a post COVID-19 world.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a highly prevalent infectious disease. Currently, organs are not being transplanted from donors who are SARS-CoV-2 positive. It remains unclear as to how to differentiate active from recovered patients. We report our recent experience of a 3-month-old deceased organ donor who died as the result of an anoxic brain injury after a cardiopulmonary arrest (presumed sudden infant death syndrome). The child was born to a mother presumed to have coronavirus disease 2019. The donor tested negative for SARS-CoV-2 reverse transcriptase-polymerase chain reaction and positive for SARS-CoV-2 immunoglobulin A antibodies. We suspect this is the first known report of its kind and noteworthy for the organ donation and transplantation community.