Performance of commercial SARS-CoV-2 wild-type and Omicron BA.1 antibody assays compared with pseudovirus neutralization tests.

BACKGROUND: Commercially available ELISA-based antibody tests are used to approximate vaccination success against SARS-CoV-2 in at-risk patients, but it is unclear whether they correlate with neutralization of the Omicron variant. METHODS: 269 serum samples of a cohort of 44 non-immunosuppressed participants and 65 MTX-treated rheumatic patients taken before and after COVID-19 booster vaccinations were measured using COVID-19 antibody testing systems with wild-type and Omicron BA.1 antigens developed by three different manufacturers (surrogate virus neutralization test cPass, and binding antibody tests QuantiVac and SeraSpot), as well as with a pseudovirus neutralization test (pVNT). The pVNT was considered the gold standard for determining the presence and level of anti-SARS-CoV-2 antibodies. RESULTS: All three wild-type ELISAs showed excellent test performance compared with wild-type neutralization in pVNT. However, out of 56 samples without Omicron BA.1 neutralization in pVNT, 71.4% showed positive results in at least one and 28.6% in all three wild-type ELISAs at the manufacturer-defined cut-offs. Omicron ELISAs showed either decreased specificity (57.1% and 55.4% for binding ELISAs) or sensitivity (51.2% in cPass) compared to Omicron neutralization in pVNT. The proportion of any false positive results among all samples decreased from 26.5% before to 3.2% after booster vaccination, however binding antibody test specificities remained below 70%. CONCLUSIONS: We found a poorer test performance of new Omicron antibody test systems compared to wild-type tests in detecting neutralizing antibodies against the corresponding SARS-CoV-2 variants. Decisions for booster vaccination or passive immunization of at-risk patients should not be based solely on antibody test results.

Economic Resilience in a Pandemic: Did COVID-19 Policy Effects Override Industry Diversity Impacts in Australia?

The industry diversity thesis of economic resilience to economic shocks is embedded in community development policy across Australia. The idea being that in the event of an economic shock some industries will prove more recession-proof than others. The greater the industry diversity, the greater the likelihood of off-setting industry effects, resulting in greater economic resilience. The COVID-19 pandemic and the associated restrictions created a unique natural experiment to explore whether the industry diversity thesis holds true under the conditions of a global health pandemic. In this policy paper, we use JobKeeper applications as a proxy for decreased economic resilience. We explore if Australian local government areas (LGAs) with higher industry diversity had less necessity for JobKeeper. We also briefly consider if concentrations of certain industries acted as a better economic buffer to the COVID-19 economic shock. We observe that as diversity increases, economic resilience strengthens except for Victoria (where the association is inverted). This observation has important implications for current and future policy formation and implementation across all layers of government. © 2023 The Authors. Economic Papers;A journal of applied economics and policy published by John Wiley & Sons Australia, Ltd on behalf of The Economic Society of Australia.

COVID-19 and remittances to Mexican states

With the onset of the COVID-19 pandemic and its negative effect on economic activity, a decrease in remittances was expected. However, on the contrary, remittances have increased in countries like Mexico. Using a fixed-effect model with information at the state level, this study finds evidence that the increase in COVID-19 cases was associated with a higher level of remittances to Mexican states, allowing some degree of insurance against the pandemic. However, remittances did not respond to the decrease in employment caused by the pandemic in local economies. A portion of the observed increases in remittances during the pandemic can be explained by factors at the national level. © 2023, Oviedo University Press. All rights reserved.

HEALTHCARE EXPENDITURE AND CARE SEEKING PATTERNS AMONG PEOPLE WITH CHRONIC CONDITIONS DURING THE PANDEMIC

Objective: Public health strategies resorted to world-wide, to reduce the transmission of COVID-19 had economic impacts which led to care seeking changes among people with pre-existing chronic diseases. We aimed to assess the household expenditure and, care seeking among people with chronic diseases due to COVID-19 pandemic in Sri Lanka. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%;n = 173) responded that they experienced a negative impact on their main income. Nearly 30%(n = 130) of the participants had an additional source of income before the pandemic;and of them majority (74%;n = 97) reported a negative impact on the income. Twenty six percent (n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. The pandemic led to changes in healthcare utilization patterns among patients. Majority had to obtain the drugs from the pharmacy 65% (n = 70) and the laboratory tests from private labs 58% (n = 62). Forty-eight percent agreed that the pandemic led to delays in healthcare seeking, mostly because they were unaware of the services rendered. The incurred high OOPE during the pandemic. Of the participants, 9% (n = 39) and 3.2% (n = 14) had incurred catastrophic healthcare expenses at 10% and 25% of their total income. Conclusions: Residents of the Western-province were severely economically affected by the COVID-19 pandemic. Participants had incurred high out-of-pocket expenditures which led to changes in care seeking patterns among people chronic conditions. Strategies to ensure continuity of care especially for chronic conditions while protecting people from financial hardships is necessary to move towards Universal Health Coverage.

REDUCED HEALTHCARE UTILIZATION AMONG PATIENTS WITH CHRONIC DISEASES DURING THE PANDEMIC

Objective: Public-health strategies resorted to world-wide, to reduce the transmission of COVID-19 impacted the healthcare-utilization of people with preexisting chronic diseases. We aimed to assess the healthcare utilization, patientexperiences and economic impacts among people with chronic diseases due to COVID-19 pandemic. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants sociodemographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%) responded that they experienced a negative impact on their main income. 26%(n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30) reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. Considering care seeking pattern among people with chronic illness, it declined in all institutions during the lockdown period. However careseeking in the private sector, only margially declined during the pandemic. Considering care seeking at a government hospital, a drastic drop was observed during the lockdown period (n = 13;= 11.3%). Of the respondents who sought healthcare for chronic illness during the pandemic in lockdown (n = 85;74%) and no-lock down (n = 107;93%), a considerable proportion mentioned that clinics were either not functioning on time or not functioning at all. Although the majority agreed that their perceived health despite the chronic illness was good, very good, or excellent, around 38% reported it as fair or poor. Conclusion: Health-care utilization among people with a chronic disease reduced due to supply and demand driven factors in healthcare. Efforts are necessary to ensure continuity of care for people with chronic disease to prevent complications. The government needs to invest in resilient health systems to be better equipped to provide uninterrupted care for NCDs in any circumstances. To support this, primary healthcare strengthening and tele-health options should be explored.

PAUSING METHOTREXATE IMPROVES IMMUNOGENICITY of COVID-19 VACCINATION in PATIENTS with RHEUMATIC DISEASES

Background: Several research groups have recently described a reduced vaccination response to COVID-19 vaccination under methotrexate (MTX) (1,2). The increase in humoral immune response when pausing MTX two weeks after vaccination has already been described for infuenza vaccination (3). However, data regarding MTX-hold during COVID-19 vaccination are still lacking. Objectives: To study the effect of MTX and its discontinuation on the humoral immune response after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD). Methods: In this retrospective study, neutralising SARS-CoV-2 antibodies were measured after second vaccination in 64 rheumatic patients on methotrexate therapy, 31 of whom temporarily paused medication without a fxed regimen. The control group consisted of 21 AIRD patients without immunosuppressive medication. Results: MTX patients showed a signifcantly lower mean antibody response compared to AIRD patients without immunosuppressive therapy (71.8 % vs 92.4 %, p<0.001). For patients taking MTX, age correlated negatively with immune response (r=-0.49;p<0.001). All nine patients with antibody levels below the cutoff were older than 60 years. Patients who held MTX during at least one vaccination showed signifcantly higher mean neutralising antibody levels after second vaccination, compared to patients who continued MTX therapy during both vaccinations (83.1 % vs 61.2 %, p=0.001). This effect was particularly pronounced in patients older than 60 years (80.8 % vs 51.9 %, p=0.001). The impact of the time period after vaccination was greater than of the time before vaccination with the critical cut-off being 10 days. Conclusion: MTX reduces the immunogenicity of SARS-CoV-2 vaccination in an age-dependent manner. Our data further suggest that holding MTX for at least 10 days after vaccination signifcantly improves the antibody response in patients over 60 years of age.

Counting on U training to enhance trusting relationships and mental health literacy among business advisors: protocol for a randomised controlled trial.

BACKGROUND: Financial distress is thought to be a key reason why small-medium enterprise (SME) owners experience higher levels of mental health conditions compared with the broader population. Business advisors who form trusting, high-quality relationships with their SME clients, are therefore well placed to: (1) help prevent/reduce key sources of financial distress, (2) better understand the business and personal needs of their clients and, (3) recognise the signs and symptoms of mental health conditions and encourage help-seeking where appropriate. The aim of this study is to compare the effectiveness of relationship building training (RBT) combined with mental health first aid (MHFA) training for business advisors with MHFA alone, on the financial and mental health of their SME-owner clients. METHODS: This is a single blind, two-arm randomised controlled trial. Participants will be business advisors who provide information, guidance and/or assistance to SME owner clients and are in contact with them at least 3 times a year. The business advisors will invite their SME-owner clients to complete 3 online surveys at baseline, 6- and 12-months. Business advisors will be randomised to one of two conditions, using a 1:1 allocation ratio: (1) MHFA with RBT; or (2) MHFA alone, and complete 3 online surveys at baseline, 2- and 6-months. Primary outcomes will be measured in the business advisors and consist of the quality of the relationship, stigmatizing attitude, confidence to offer mental health first aid, quality of life and provision of mental health first aid. Secondary outcomes will be measured in the SME owners and includes trust in their business advisors, the quality of this relationship, financial wellbeing, financial distress, psychological distress, help-seeking behaviour, and quality of life. To complement the quantitative data, we will include a qualitative process evaluation to examine what contextual factors impacted the reach, effectiveness, adoption, implementation, and maintenance of the training. DISCUSSION: As there is evidence for the connections between client trust, quality of relationship and financial and mental wellbeing, we hypothesise that the combined RBT and MHFA training will lead to greater improvements in these outcomes in SME owners compared with MHFA alone. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04982094 . Retrospectively registered 29/07/2021. The study started in February 2021 and the recruitment is ongoing.

Opportunities to prevent and manage undernutrition to amplify efforts to end TB.

The bidirectional relationship between TB and nutrition is well recognized - primary undernutrition is a risk factor for developing TB disease, while TB results in wasting. Although nutrition support is acknowledged as an important intervention in TB programmes, it is seldom afforded commensurate priority for action. TB incidence and deaths worldwide are falling too slowly to meet WHO End TB Strategy milestones, and the number of undernourished people is increasing, likely to be further exacerbated by the ongoing COVID-19 pandemic. Undernutrition needs to be more urgently and intensively addressed. This is especially true for the WHO South-East Asia Region, where the high rates of undernutrition are a key driver of the TB epidemic. The evidence base has been sufficiently robust for clear and workable programmatic guidance to be formulated on assessment, counselling and interventions for TB patients. Many high-burden countries have developed policies addressing TB and nutrition. Gaps in research to date have frustrated the development of more refined programmatic approaches related to addressing TB and malnutrition. Future research can be shaped to inform targeted, actionable policies and programmes delivering dual benefits in terms of undernutrition and TB. There are clear opportunities for policy-makers to amplify efforts to end TB by addressing undernutrition.

Dengue and leptospirosis infection during the coronavirus 2019 outbreak in Sri Lanka.

A significant decrease in dengue fever cases and a contrasting increase in leptospirosis cases were reported for the second quarter of 2020 compared with 2019 in Sri Lanka. In the absence of significant environmental and weather-related differences to account for these changes in incidence, we investigated the possibility that the effects of the COVID-19 pandemic on public health, social behaviour and the restrictions imposed during the lockdown influenced the fluctuations in dengue and leptospirosis infections.

COVID-19 and gastroenterology: clinical insights and recommendations for gastroenterology care providers.

While the COVID-19 pandemic evolves, we are beginning to understand the role the gastrointestinal tract plays in the disease and the impact of the infection on the care of patients with gastrointestinal (GI) and liver diseases. We review the data and understanding around the virus related to the digestive tract, impact of the pandemic on delivery of GI services and daily gastroenterology clinical practice, and the effects on patients with pre-existing GI diseases.