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2.
Mmwr-Morbidity and Mortality Weekly Report ; 71(36):1151-1154, 2022.
Article in English | Web of Science | ID: covidwho-2068408

ABSTRACT

What is already known about this topic? Before emergence of the SARS-CoV-2 B.1.1.529 (Omicron) variant, infectious SARS-CoV-2 was unlikely to be cultured at high cycle threshold (Ct) values. Based on this, low Ct values, which are suggestive of high RNA levels, are sometimes used as surrogate markers for infectiousness. What is added by this report? In a longitudinal study including daily nasal swabbing, although Omicron BA.1 sublineage infections exhibited higher Ct values than did pre-Omicron infections, culturable Omicron virus was still detected. Among virus-positive specimens, Ct values were higher for Omicron than for pre-Omicron specimens, especially during the first week of illness. What are the implications for public health practice? Supporting CDC guidance, these data show that Ct values likely do not provide a consistent proxy for infectiousness across SARS-CoV-2 variants.

3.
Hong Kong Journal of Emergency Medicine. ; 2022.
Article in English | EMBASE | ID: covidwho-2064576

ABSTRACT

Background: The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005. Objective(s): To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID-19 pandemic. Method(s): A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020. Result(s): A total of 3633 poisoning cases were analysed. Compared to 2019 (pre-COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0-12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13-19 years) poisoning seemed to be unaffected by the COVID-19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed. Conclusion(s): This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID-19 pandemic. It also highlighted important changes and possible effects of the COVID-19 pandemic on poisoning in Hong Kong in comparison with our previous reports. Copyright © The Author(s) 2022.

4.
Organizational Behavior and Human Decision Processes ; 172, 2022.
Article in English | Scopus | ID: covidwho-2061730

ABSTRACT

How do individuals react to the sudden public moralization of their work and with what consequences? Extant research has documented how public narratives can gradually moralize societal perceptions of select occupations. Yet, the implications of how workers individually respond and form self-narratives in light of—or in spite of—a sudden moralizing event remain less understood. Such an understanding is even more critical when workers are weakly socialized by their organization, a situation increasingly common today. During the COVID-19 pandemic, radically shifting public narratives suddenly transformed grocery delivery work, previously uncelebrated, into highly moralized “heroic” pursuits. Drawing on interviews (n = 75), participant artifacts (n = 85), and archival data (e.g., newspaper articles), we find that these workers (here, shoppers on the platform organization Instacart), left mainly to themselves, exhibited varying responses to this moralizing and that their perceived relations to the organization, customers, and tasks shaped these responses. Surprisingly, those who facilely adopted the hero label felt morally credentialled, and they were thus likely to minimize their extra-role helping of customers and show low commitment to the organization;in contrast, those who wrestled with the hero narrative sought to earn those moral credentials, and they were more likely to embrace extra-role helping and remain committed to moralized aspects of the work. Our study contributes to literatures on the moralization of work and narratives by explaining why some workers accept a moralized narrative and others reject or wrestle with it, documenting consequences of workers’ reactions to such narratives, and suggesting how a moralized public narrative can backfire. © 2022 Elsevier Inc.

5.
Investigative Ophthalmology and Visual Science ; 63(7):4351-A0288, 2022.
Article in English | EMBASE | ID: covidwho-2057703

ABSTRACT

Purpose : To compare corneal transplant failure in patients who have been vaccinated against COVID-19 to a control group of patients who have received an influenza vaccination. Methods : A retrospective cohort study was conducted using TriNetX, a federated electronic health records research network comprising data from more than 50 health organizations in the United States. Patients who underwent corneal transplantation and either COVID-19 vaccination or Influenza A vaccination were identified by CPT and medication codes and separated into cohorts based which vaccination they had received. COVID-19 vaccination was defined as receiving either 2 doses of Moderna or Pfizer COVID19 Vaccine or 1 dose of J&J's COVID-19 Vaccine. Cohorts were matched for age, gender, body mass index, and medical comorbidities (essential hypertension, diabetes mellitus, chronic lower respiratory diseases, heart failure, nicotine dependence, and alcohol related disorders). The primary outcome was corneal graft failure at 120 days after corneal transplantation surgery. The relative risk for this outcome was compared between each cohort before and after 1:1 propensity score matching. Results : A study population of 784 corneal transplant patients who received COVID-19 vaccination and a control population of 1661 patients who received Influenza A vaccination were identified. After propensity matching, 715 matched patients from each cohort were compared. The incidence of corneal transplant failure rate was 1.8% for the COVID-19 vaccine cohort and 1.6% for the Influenza A cohort. While the rate of corneal transplant failure was slightly lower in COVID-19 vaccine recipients in comparison to Influenza vaccine recipients (RR=0.92%, CI 0.42-2.01), this result was not statistically significant (p 0.84). Conclusions : While there have been several case reports of corneal graft failure after COVID-19 or COVID-19 vaccination, there appears to be no statistically significant impact of the COVID-19 vaccine on corneal transplant failure in this retrospective cohort study. Additionally, corneal graft rejection in vaccinated patients was rare in our study.

6.
Investigative Ophthalmology and Visual Science ; 63(7):1671-A0501, 2022.
Article in English | EMBASE | ID: covidwho-2058092

ABSTRACT

Purpose : To systematically investigate ocular changes in autopsied eyes from fatal cases of Coronavirus disease 2019 (COVID-19) and to investigate the localization of severe acute respiratory syndrome coronavirus (SARS-CoV-2) within ocular structures. Methods : Macroscopic and microscopic histopathological evaluation was performed and the localization of SARS-CoV-2 RNA within ocular tissues investigated using an in situ hybridization (ISH) technique in 13 eyes. Contralateral eyes were freshly dissected, and droplet digital polymerase chain reaction (ddPCR) assay was performed on ocular fluids and tissues to quantify SARS-CoV-2 RNA. Results : A total of 21 fatal COVID-19 cases were included (mean age, 60.2 years [range, 27- 91 years];23.8% female). Histopathological abnormalities include vascular changes (61.9%), cytoid bodies (52.4%), and retinal edema (23.8%) with minimal inflammation (0.09%) were observed. Non-CMV viral inclusions were identified in one eye. No CMV positivity was detected. Of the 21 contralateral eyes tested by ddPCR, 14 tested positive for SARS-CoV-2. Using ddPCR and ISH, SARS-CoV-2 localization was observed in the following ocular tissues and fluid: cornea (27.3%), aqueous (26.3%), lens (54.5%), vitreous (15.0%), retina (22.2%), choroid/sclera (47.4%), and optic nerve (50.0%). The choroid/sclera, optic nerve and lens were the most frequent ocular structures found to be ddPCR positive. Evidence of replication was detected in four cases. Conclusions : Our results suggest that SARS-CoV-2 localizes to intraocular tissues. However, histological changes observed are likely a secondary hemodynamic change rather than primary effect of the virus.

7.
HKIE Transactions Hong Kong Institution of Engineers ; 29(2):120-128, 2022.
Article in English | Scopus | ID: covidwho-2026608

ABSTRACT

During these difficult times of COVID-19, people are struggling to return to their normal routines, including going back to schools and workspaces. To prevent the spread of the disease, wearing face masks is essential for everyone to protect themselves and the ones around them. However, challenges arise in regard to enforcement of wearing masks in large crowds such as at educational centres and public transportation. This paper proposes a robust automatic system for face mask detection using transfer learning kits from NVIDIA. Based on the backbone of Resnet-18, the model results in high accuracy in the distinguishing of persons who do and do not wear masks. Leveraged by the NVIDIA edge accelerator, the system can run in real-time environments, making it applicable in various venues. Its feasibility was demonstrated by deploying the approach in an education centre in Hong Kong. © 2022, Hong Kong Institution of Engineers. All rights reserved.

8.
Journal of General Internal Medicine ; 37:S286-S287, 2022.
Article in English | EMBASE | ID: covidwho-1995618

ABSTRACT

BACKGROUND: The health and financial burdens faced by cancer survivors, compounded by the significant disruption in care and their increased risk for morbidity and mortality during the COVID-19 pandemic, emphasize the need to assess the mental health impact of the pandemic in this population. We examined the association between beliefs about COVID and posttraumatic stress disorder (PTSD) symptoms among breast and prostate cancer survivors. METHODS: Participants from two longitudinal cohort studies completed surveys assessing their beliefs about COVID- 19, as well as stress and PTSD symptoms. COVID beliefs were assessed using questions adapted from a previous coronavirus survey developed through an iterative process. PTSD symptoms were assessed using the PTSD Checklist (PCL-5). Participants with PCL-5 scores ≥ 33 were classified as having COVID-related PTSD symptoms. Surveys were completed between May 2020 and June 2021 and were categorized into four time points: season 1 from May 2020 to August 2020, season 2 from September 2020 to November 2020, season 3 from December 2020 to February 2021 and season 4 from March 2021 to June 2021. Chi-square, Fisher, Signed Rank Wilcoxon tests and general linear models were performed to assess the relationships between COVID beliefs and PTSD symptoms. RESULTS: Participants were 276 older cancer survivors (mean age 67 years), of whom 157 (57%) were female and had breast cancer and 118 (43%) were male with prostate cancer. Seventy (25%) self-identified as Black, 147 (53%) as White, and 36 (13%) identified as Latinx. Twenty-four participants (7%) had COVID-related PTSD symptoms. Participants with PTSD symptoms were more likely to be very worried about getting COVID (65% vs. 33%, p=0.007), more likely to think that ≥10% of people with COVID would die (75% vs. 40%, p=0.006), and that it was very likely that they or someone they know will get sick from COVID (64% vs. 23%, p=0.006). As the pandemic drew on, cancer survivors' beliefs about COVID changed such that fewer respondents reported that COVID changed their daily routine a lot in season 4 compared to season 1 (88% vs 65%, p <0.001), and fewer were very worried about getting COVID (38% vs. 19%, p=0.056). Temporality was also significantly associated with a decrease in PTSD symptoms with average PCL-5 scores decreasing from 14.2 to 8.9 in season 1 compared to season 4 (p <0.0001). CONCLUSIONS: As the pandemic progressed, cancer survivors tended to have decreased levels of PTSD symptoms, were less likely to have their routines disrupted and were less worried about getting COVID. However, among participants who had PTSD symptoms, concerns about COVID were significantly higher than among those without PTSD symptoms, emphasizing the need for mental health screening and counseling to better support survivors' coping with the impacts of the pandemic.

9.
Medical Imaging 2022: Image Processing ; 12032, 2022.
Article in English | Scopus | ID: covidwho-1901888

ABSTRACT

We propose a fast and robust multi-class deep learning framework for segmenting COVID-19 lesions: Ground-Glass opacities and High opacities (including consolidations and pleural effusion), from non-contrast CT scans using convolutional Long Short-Term Memory network for self-attention. Our method allows rapid quantification of pneumonia burden from CT with performance equivalent to expert readers. The mean dice score across 5 folds was 0.8776 with a standard deviation of 0.0095. A low standard deviation between results from each fold indicate the models were trained equally good regardless of the training fold. The cumulative per-patient mean dice score (0.8775±0.075) for N=167 patients, after concatenation, is consistent with the results from each of the 5 folds. We obtained excellent Pearson correlation (expert vs. automatic) of 0.9396 (p<0.0001) and 0.9843 (p<0.0001) between ground-glass opacity and high opacity volumes, respectively. Our model outperforms Unet2d (p<0.05) and Unet3d (p<0.05) in segmenting high opacities, has comparable performance with Unet2d in segmenting ground-glass opacities, and significantly outperforms Unet3d (p<0.0001) in segmenting ground-glass opacities. Our model performs faster on CPU and GPU when compared to Unet2d and Unet3d. For same number of input slices, our model consumed 0.83x and 0.26x the memory consumed by Unet2d and Unet3d. © 2022 SPIE

10.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880885
11.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880858
12.
Fertility and Sterility ; 116(3 SUPPL):e170, 2021.
Article in English | EMBASE | ID: covidwho-1880415

ABSTRACT

OBJECTIVE: To significantly reduce the number of in person visits during an IVF cycle without compromising cycle outcomes, patient safety, or patient satisfaction. MATERIALS AND METHODS: This was a multi-modal QI initiative at an academic fertility centre. After the temporary closure of many fertility services across IVF clinics in North America in March 2020, we identified that new policies and procedures were necessary in order to safely resume patient care during a pandemic. The primary intervention of this study was a change in our IVF monitoring protocol. Our default settings in our electronic medical record order sets were changed, and education sessions were held for clinic staff. Baseline data was collected from 2019 for comparison. A patient satisfaction survey using a 5-point likert scale was created and sent to every patient undergoing IVF on the day of their oocyte retrieval. The number of in person visits during an IVF cycle were counted for each patient undergoing treatment from June 2020 to August 2020. This was compared to the number of in person visits during the same time frame in 2019. Balancing measures included patient satisfaction, pregnancy rates, risk and incidence of ovarian hyperstimulation syndrome (OHSS), incidence of cycle cancellation, and number of eggs retrieved per cycle. Pre- and postintervention data was compared using univariate and multivariate poisson models to control for patient characteristics such as age, AMH, and BMI. RESULTS: A significant reduction in the number of in person visits (8 vs 4, p<0.001) during an IVF treatment cycle was observed post-intervention compared with the previous year. There was no significant difference in pregnancy rates, risk or incidence of OHSS, cycle cancellation, or number of eggs retrieved per cycle. Patient surveys were reassuring that the intervention did not change patient experience or satisfaction. CONCLUSIONS: IVF Monitoring Protocol changes aimed at reducing the number of in person visits allowed our team to continue to provide ongoing care for patients during the Covid-19 pandemic without compromising IVF outcomes or patient satisfaction. IMPACT STATEMENT: This study allows for safer and socially distanced care for patients undergoing IVF cycles during a pandemic, and will also shape our future practise of cycle monitoring during IVF stimulation as we have shown that a reduction in bloodwork and ultrasound does not negatively impact patient outcomes.

13.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-337475

ABSTRACT

Background: The rapid spread of SARS-CoV-2 worldwide has led to the emergence of new variants due to the presence of mutations that alter viral characteristics, but there have been few studies on trends in viral lineages in Japan, an island country. We hypothesized that changes in cycle threshold (Ct) values on reverse transcription polymerase chain reaction (RT-PCR) reflect the prevalent variants during a given period. Methods: We performed next-generation sequencing of positive samples to identify the viral lineages in Japan in 2021 and compared variant prevalence with the average Ct values on routine RT-PCR using 4 primer sets. Results: Based on 3 sequencing runs, the highly transmissible Alpha variant, which prevailed over other lineages, such as R.1, from April 2021, was dominated by the even stronger Delta variant between July and August 2021 in Japan. The decrease in our routine RT-PCR Ct values with 4 primer sets correlated with these fluctuations in lineage prevalence over time. Conclusions: We confirmed that our RT-PCR protocol reflects the trends in SARS-CoV-2 variant prevalence over time regardless of sequence mutation. This may aid in the tracking of new variants in the population.

15.
8th International Conference on Computational Science and Technology, ICCST 2021 ; 835:261-272, 2022.
Article in English | Scopus | ID: covidwho-1787759

ABSTRACT

The COVID-19 pandemic arises in the year 2020 that leads to almost more than 100,000,000 confirmed cases happened in worldwide and yet, the cases are continuing to rise now. One of the common methods that used to prevent the COVID-19 is through keeping the social distancing between each other. However, people do not aware of the importance of applying social distancing rules. A low-cost solution is urgently needed for contact tracing and remind the users to keep the social distancing with the others. An IoT-based safety distance monitoring (ISDM) device is proposed to monitor safety distance, remind people to always stay alert and keep the data of the users that violated the social distancing rules for contact tracing. ISDM is a lightweight wearable wristwatch. Bluetooth Low Energy technique is used to send and receive information such as body temperature and contact tracing information. Fever is the most common symptom of COVID-19 patients. ISDM can operate either online or offline. The health and contact tracing information are stored in a local Micro-SD card storage when offline and data will be uploaded to the cloud server for further analysis once ISDM is connected. The detailed contact tracing information can be used to trace the potential COVID-19 patients with close contact with the COVID-19 patient. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

16.
Hong Kong Med J ; 28(4): 300-305, 2022 08.
Article in English | MEDLINE | ID: covidwho-1753980

ABSTRACT

INTRODUCTION: In response to two nosocomial clusters of coronavirus disease 2019 (COVID-19) in our hospital, we adopted a series of strict infection control measures, including regular rapid antigen test (RAT) screening for high-risk patients, visitors, and healthcare workers. We evaluated the diagnostic performance of a locally developed RAT, the INDICAID COVID-19 Rapid Antigen Test (Phase Scientific, Hong Kong), using respiratory samples from both symptomatic and asymptomatic individuals. METHODS: Real-time reverse-transcription polymerase chain reaction (rRT-PCR)-confirmed deep throat saliva (DTS) and pooled nasopharyngeal swab and throat swab (NPS/TS) samples collected from 1 November to 30 November 2020 were tested by INDICAID. Screening RATs were performed on asymptomatic healthcare workers during a 16-week period (1 December 2020 to 22 March 2021). RESULTS: In total, 20 rRT-PCR-confirmed samples (16 DTS, four pooled NPS/TS) were available for RAT. Using the original sample, RAT results were positive in 17/20 samples, indicating 85% sensitivity (95% confidence interval [CI]=62.11%-96.79%). Negative RAT results were associated with higher cycle threshold (Ct) values. For samples with Ct values <25, the sensitivity was 100%. Of the 49 801 RATs collected from healthcare workers, 33 false positives and one rRT-PCR-confirmed case were detected. The overall specificity was 99.93% (95% CI=99.91%-99.95%). The positive and negative predictive values were 2.94% (95% CI=2.11%-4.09%) and 100%, respectively. CONCLUSION: The INDICAID COVID-19 RAT demonstrated good sensitivity for specimens with high viral loads and satisfactory specificity for low-risk, asymptomatic healthcare workers.


Subject(s)
COVID-19 , COVID-19/diagnosis , COVID-19/epidemiology , Disease Outbreaks , Hong Kong/epidemiology , Hospitals, Private , Humans , SARS-CoV-2 , Sensitivity and Specificity
17.
Radiotherapy and Oncology ; 163:S54-S55, 2021.
Article in English | EMBASE | ID: covidwho-1747453

ABSTRACT

Purpose: The purpose of patient education is to maintain or improve health throughout the cancer care journey, from diagnosis to treatment and beyond. COVID-19 has undeniably created a shift in the delivery of cancer care education with the transition to virtual care and enforcement of visitor restrictions. This has hindered equity and inclusion for patients with limited English proficiency (LEP) as they rely heavily on family members to be ad hoc interpreters. Language barriers are linked to less health education, lower interpersonal care and lower patient satisfaction. At the time of the project, professional over-the phone interpreters were used infrequently. The purpose of this project was to investigate alternate methods to enhance patient education for patients with LEP. Materials and Methods: A needs assessment was completed by surveying staff about their perspectives on current LEP education and interpreter use in the department, and patients to determine their comfort in communicating with radiation therapists and their preferred interpretation methods. After assessing the results of the needs assessment and examining interpretation options, professional video interpretation was implemented in February 2020. Interpreter usage has been tracked and post-implementation evaluation conducted with staff and patients. Results: According to the staff survey (n=69), professional over-the-phone interpreters were used least at 8% compared to other methods due to inconvenience and time constraints. Although family members (59%) and bilingual staff (62%) are most commonly used for convenience, decreased accuracy and workflow disruption were significant concerns. In addition, of the 34 staff that are fluent in a second language, only 6% stated that they were ‘very comfortable' in interpreting medical conversations. Patient surveys (n=12) indicated that 67% of LEP patients were not aware that the hospital offered free interpretation services. When asked if they were comfortable asking questions or discussing side effects with their therapists, only 36% and 40% were very comfortable, respectively. When asked which interpretation method they would most prefer for daily interactions, patients and staff showed similar results with bilingual staff members as most preferred (35%), professional face-to-face interpreters (30%), family member or friend (22%) and professional over-the-phone interpreters (13%). With the implementation of professional video interpretation, professional interpreter usage increased two-fold after COVID-19 visitor restrictions were enforced. Positive feedback has been received by both patients and staff. Conclusions: The needs assessment analysis revealed that ad hoc interpretation was used most frequently and preferred by both patients and staff. However, challenges can arise if family members also have LEP or are unable to accompany the patient, and if staff do not speak the patient's language. During COVID-19, the implementation of an institutional live-video interpretation service showed a two-fold usage increase since visitor restrictions were introduced. LEP patients have been more comfortable asking questions and staff have complimented the convenience and accessibility of the video interpreters. Video interpretation is a convenient tool that allows radiation oncology staff to use professional interpreters to communicate with patients virtually face-to-face and accurately provide education in their preferred language.

18.
Open Forum Infectious Diseases ; 8(SUPPL 1):S312, 2021.
Article in English | EMBASE | ID: covidwho-1746572

ABSTRACT

Background. In April 2021, Sunnybrook Health Sciences Centre opened a Mobile Health Unit (MHU, i.e. medical tents) under the direction of the Ontario Ministry of Health and Long Term Care in response to a surge in hospitalized patients with COVID-19 during wave three of the pandemic. Providing care to patients in non-conventional spaces is not new, however, experience in safely caring for COVID-19 patients in these settings is lacking. Our aim is to describe the implementation of our MHU and associated outcomes of these COVID-19 patients. Methods. A multidisciplinary clinical and operations team was created to plan, execute and operate a safe environment for COVID-19 patients and healthcare workers within the MHU. Patient selection was restricted to patients with COVID-19 who were clinically recovering from severe COVID-19 pneumonia. Ventilation was optimized with air flow directed away from patient areas, velocity reduced to below 0.25 meters per second, and air exchanges of 24-28 per hour. All healthcare workers working in the MHU were offered COVID-19 vaccine and required to complete mandatory education if they declined (vaccination rate of 87% was achieved among dedicated staff). Universal masking and eye protection was used throughout the MHU with designated areas for donning and doffing personal protective equipment. Results. In total, 32 patients with COVID-19 were managed in the MHU between 26 April and 21 May, 2021. Table 1 provides the summary of patient characteristics. All patients had a median of one-day of transmission-based precautions remaining in their course and were infected with Alpha variant with exception of one patient with the Gamma variant. Among those patients with genotyping available, all were infected with SARS-CoV-2 carrying the N501Y mutation. Four of the 32 patients required transfer to the main hospital for medical indication while the others were discharged home or to rehabilitation. None of the healthcare workers who worked within the MHU developed COVID-19 infection. Conclusion. We safely cared for patients recovering from COVID-19 infection in an MHU to support system healthcare capacity. Our experience, including the specific hierarchy of controls implemented, may be helpful for future pandemic planning.

19.
Open Forum Infectious Diseases ; 8(SUPPL 1):S496-S497, 2021.
Article in English | EMBASE | ID: covidwho-1746371

ABSTRACT

Background. Wave one of the COVID-19 pandemic in Ontario, Canada, resulted in significant institutional outbreaks associated with high case fatality among older adults. Our hospital formally partnered with congregate care homes in north Toronto to support infection control and clinical management before wave two of the COVID-19 pandemic. Our aim was to evaluate the impact of this program on resident and healthcare worker (HCW) outcomes. Methods. A multicentre quasi-experimental study was conducted comparing outcomes between wave one (March-June, 2020) and wave two (October-December, 2020) among 17 congregate care homes (4 long term care homes and 13 residential homes). During wave two, weekly meetings and 42 on-site visits were conducted along with on-site daily hospital presence for all COVID-19 outbreaks to support infection control and resident management. The primary outcomes included COVID-19-case fatality rate as well as overall resident fatality including COVID-19 and non-COVID-19 related causes. Secondary outcomes included healthcare worker COVID-19 infections, and infection control practices among homes with paired audits (n=6), including hand hygiene, use of personal protective equipment, environmental cleaning and physical distancing practices. Results. Among 2203 residents during wave one and 2287 residents during wave two, there was reduction in COVID-19 case fatality rate (38.1% vs. 13.4%;p< 0.01), overall COVID-19-related fatality (2.3% vs. 1.0%;p< 0.01) and non COVID-19 related fatality (8.3% vs. 3.5%;p< 0.01). Weekly staff testing and increased syndromic surveillance was implemented during wave two. Among 2590 staff, there were 2.6% vs.4.2% staff who tested positive for COVID-19 during wave one and two, respectively. Changes in infection control practice were observed in regard to directly observed hand hygiene (83.3% vs. 100%), use of personal protective equipment (16.7% vs. 83.3%), environmental cleaning (66.7% vs. 100%) and physical distancing (66.7% vs. 83.3%). Conclusion. Integration of hospital with community congregate care homes was associated with improvements in resident outcomes during wave two of the pandemic. Further longitudinal support and evaluation is needed to ensure sustainability.

20.
MEDLINE; 2020.
Preprint in English | MEDLINE | ID: ppcovidwho-329976

ABSTRACT

COVID-19 pandemic is the third zoonotic coronavirus (CoV) outbreak of the century after severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) since 2012. Treatment options for CoVs are largely lacking. Here, we show that clofazimine, an anti-leprosy drug with a favorable safety and pharmacokinetics profile, possesses pan-coronaviral inhibitory activity, and can antagonize SARS-CoV-2 replication in multiple in vitro systems, including the human embryonic stem cell-derived cardiomyocytes and ex vivo lung cultures. The FDA-approved molecule was found to inhibit multiple steps of viral replication, suggesting multiple underlying antiviral mechanisms. In a hamster model of SARS-CoV-2 pathogenesis, prophylactic or therapeutic administration of clofazimine significantly reduced viral load in the lung and fecal viral shedding, and also prevented cytokine storm associated with viral infection. Additionally, clofazimine exhibited synergy when administered with remdesivir. Since clofazimine is orally bioavailable and has a comparatively low manufacturing cost, it is an attractive clinical candidate for outpatient treatment and remdesivir-based combinatorial therapy for hospitalized COVID-19 patients, particularly in developing countries. Taken together, our data provide evidence that clofazimine may have a role in the control of the current pandemic SARS-CoV-2, endemic MERS-CoV in the Middle East, and, possibly most importantly, emerging CoVs of the future.

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