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1.
Renal Society of Australasia Journal ; 17(2):54-61, 2021.
Article in English | Web of Science | ID: covidwho-2026597

ABSTRACT

Objective The spread of the coronavirus disease (COVID-19) pandemic has created an opportunity to re-evaluate and refine existing models of healthcare delivery for patients receiving dialysis at home. This study aims to explore the experiences of home dialysis nurses during the pandemic. Methods This was an observational study via survey. Participants were recruited through the home dialysis nursing networks in Australia and the province of Ontario, Canada. Results A total of 45 nurses responded to the survey, 53% (n=24) from Australia and 47% (n=21) from Ontario, Canada. The nurses identified that most units had moved to 'virtual' patient visits, only seeing those patients with urgent issues in person. They also reported problems with delivery of supplies for patients, implementation of social distancing during training, difficulties for patients with navigation of telehealth platforms for `virtual' clinic visits, and staffing shortages with staff needing to stay home with any suspected COVID-19 symptoms or contact. The nurses perceived that being flexible in their roles and working hours were helpful during the pandemic, while being ready to adapt at short notice was also important. Conclusion During the COVID-19 pandemic, patients receiving home dialysis have benefited from fewer healthcare facility visits and a greater ability to adhere to social distancing measures, thus limiting exposure to COVID-19 infection. Yet, patients may face challenges relating to delay or back order of dialysis supplies and social isolation, and may struggle with telehealth platforms. Our learning experience from this pandemic will help us identify the challenges encountered and measures taken to address them.

2.
Transportation Research Record ; : 15, 2022.
Article in English | Web of Science | ID: covidwho-1868904

ABSTRACT

The coronavirus pandemic changed paratransit service dramatically, with most operators eliminating shared rides to halt disease transmission. This paper applies an estimate of disease contact exposure to actual data from New York City's Access-A-Ride (AAR) paratransit system. Scenario analyses performed using insertion heuristic trip construction showed that eliminating rideshare on the AAR system increased operating miles by 70%. We also showed contact exposure can be significantly limited (by similar to 50% to 60%) by reducing vehicle capacity from 4 to 2 passengers. Manipulating the maximum ride time factor also showed the potential to reduce contact exposure, with a 50% increase of the ratio from 2 to 3 leading to a 40% increase in contact exposure. Contact exposure was relatively insensitive to changes in the maximum wait time policy.

3.
Annals of Behavioral Medicine ; 56(SUPP 1):S171-S171, 2022.
Article in English | Web of Science | ID: covidwho-1849451
4.
Journal of the Hong Kong College of Cardiology ; 28(2):103, 2020.
Article in English | EMBASE | ID: covidwho-1743907

ABSTRACT

Introduction: Tele-cardiac rehabilitation has demonstrated safety and efficacy in several clinical studies. With the outbreak of COVID-19, the centered-based CR service was totally suspended. To facilitate patients to exercise at home while being monitored. A pilot home-based cardiac tele-rehabilitation program was developed with a structured protocol at Princess Margaret Hospital (PMH) and rolled out from October 2020. Objectives: 1. To minimize the impact of suspension of in-hospital CR service due to outbreak of COVID-19. 2. To evaluate the effects and develop a home-based CR program for remote rehabilitation, based on advanced technological infrastructure and complementary clinical protocols. Methodology: Target patients: Low risk cardiac patients who fulfil the intake criteria, able and willing to use digital monitoring devices including blood pressure machine, smart watch and smart phone. Program design: The program will last for 12 weeks and consists of education, exercise training and relaxation training. Each consenting patient will be given a training kit containing a training log-book, informative educational leaflets and a set of QR codes to access our home-made education, exercise training & relaxation practice videos. Individual phone consultation by multidisciplinary will be scheduled once a week at the first five weeks. Patients can view the video at their own convenience, and then discuss or ask questions during phone follow-up. Individualized exercise will be prescribed according to patients' age, mobility and cardio fitness level. Patients can follow the designated video to do exercise at home. They will be instructed to measure and record their blood pressure, heart rate, and rate perceived exertion (RPE) before and after exercise. Physiotherapist will phone call patient to monitor and coach patients. Evaluation: All patients will undergo a detailed face-to-face assessment at baseline and at 12-week. They are including 6-minute walk test, body mass index (BMI), waist circumference, blood test for lipid profile, etc. In addition, patients will also request to fill in a set of questionnaires to measure the physical activity level, functional performance and psychological fitness. Conclusion: It believes that tele-rehabilitation is a more cost-effective model compared to center-based CR. It enables a new direction for the CR program.

7.
Journal of the Canadian Association of Gastroenterology ; 5(Suppl 1):114-115, 2022.
Article in English | EuropePMC | ID: covidwho-1695333

ABSTRACT

Background The COVID-19 pandemic has brought significant challenges to clinicians caring for liver transplant (LT) recipients. Researchers have sought to better understand the risk and clinical outcomes of LT recipients infected with COVID-19 globally, however, there is a paucity of data from within Canada. Aims Our multi-center study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 in Canada. Methods We identified a retrospective cohort of adult LT recipients with RT-PCR confirmed COVID-19 from 7 Canadian tertiary care centers between March 2020 and June 2021. Demographic and clinical data were compiled by clinicians within those centers. We identified liver enzyme profile at the time of COVID-19 infection, immunosuppression type and post-infection adjustments, rate of hospitalization, ICU admission, mechanical ventilation, and death. Results A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, the median time from LT was 66 months (1, 128) and the median age at COVID-19 infection was 59 years (52, 65). At COVID-19 diagnosis, the median ALT was 37 U/L (21, 41), AST U/L was 34 (20, 37), ALP U/L was 156 (88, 156), Total Bilirubin was 11 umol/L (7, 14), and INR was 1.1 (1.0, 1.1). The majority of patients (92%) were on tacrolimus monotherapy or a combination of tacrolimus and mycophenolate mofetil (MMF);median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (4.0, 8.1). Immunosuppression was modified in 8 (16%) patients post-infection;either the tacrolimus dose was reduced or MMF was held. One patient developed acute cellular rejection which recovered after re-initiation of the prior regimen. Eighteen patients (37%) required hospitalization, 6 (12%) were treated with dexamethasone, and 3 (6%) required ICU admission and mechanical ventilation. Four patients (8%) died due to complications of COVID-19. On univariate analysis, neither age, sex, co-morbidities nor duration post-transplant were associated with risk of hospitalization. Conclusions In our national retrospective study, approximately 40% of patients required hospitalization with a mortality rate of < 10%. Previous studies have shown proximity to LT as an independent factor for mortality with COVID-19;the median time from LT for our patients was 5 years, which may explain the lower mortality rate. Of note, the median tacrolimus levels were much lower in comparison to the target of 8–10 ug/L used in the first year post-transplant. As the landscape of COVID-19 changes with vaccination, evolving treatments, and increasing rates of variant transmission, additional studies are required to continue identifying trends in clinical outcomes. Funding Agencies None

8.
J Clin Invest ; 132(2)2022 01 18.
Article in English | MEDLINE | ID: covidwho-1633624

ABSTRACT

Memory B cells (MBCs) can provide a recall response able to supplement waning antibodies (Abs) with an affinity-matured response better able to neutralize variant viruses. We studied a cohort of elderly care home residents and younger staff (median age of 87 years and 56 years, respectively), who had survived COVID-19 outbreaks with only mild or asymptomatic infection. The cohort was selected because of its high proportion of individuals who had lost neutralizing antibodies (nAbs), thus allowing us to specifically investigate the reserve immunity from SARS-CoV-2-specific MBCs in this setting. Class-switched spike and receptor-binding domain (RBD) tetramer-binding MBCs persisted 5 months after mild or asymptomatic SARS-CoV-2 infection, irrespective of age. The majority of spike- and RBD-specific MBCs had a classical phenotype, but we found that activated MBCs, indicating possible ongoing antigenic stimulation or inflammation, were expanded in the elderly group. Spike- and RBD-specific MBCs remained detectable in the majority of individuals who had lost nAbs, although at lower frequencies and with a reduced IgG/IgA isotype ratio. Functional spike-, S1 subunit of the spike protein- (S1-), and RBD-specific recall was also detectable by enzyme-linked immune absorbent spot (ELISPOT) assay in some individuals who had lost nAbs, but was significantly impaired in the elderly. Our findings demonstrate that a reserve of SARS-CoV-2-specific MBCs persists beyond the loss of nAbs but highlight the need for careful monitoring of functional defects in spike- and RBD-specific B cell immunity in the elderly.


Subject(s)
Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/immunology , Immunologic Memory , Memory B Cells/immunology , SARS-CoV-2/immunology , COVID-19/epidemiology , Female , Humans , Immunoglobulin Class Switching , Male , Spike Glycoprotein, Coronavirus/immunology
9.
J Clin Invest ; 132(2)2022 01 18.
Article in English | MEDLINE | ID: covidwho-1541976

ABSTRACT

Memory B cells (MBCs) can provide a recall response able to supplement waning antibodies (Abs) with an affinity-matured response better able to neutralize variant viruses. We studied a cohort of elderly care home residents and younger staff (median age of 87 years and 56 years, respectively), who had survived COVID-19 outbreaks with only mild or asymptomatic infection. The cohort was selected because of its high proportion of individuals who had lost neutralizing antibodies (nAbs), thus allowing us to specifically investigate the reserve immunity from SARS-CoV-2-specific MBCs in this setting. Class-switched spike and receptor-binding domain (RBD) tetramer-binding MBCs persisted 5 months after mild or asymptomatic SARS-CoV-2 infection, irrespective of age. The majority of spike- and RBD-specific MBCs had a classical phenotype, but we found that activated MBCs, indicating possible ongoing antigenic stimulation or inflammation, were expanded in the elderly group. Spike- and RBD-specific MBCs remained detectable in the majority of individuals who had lost nAbs, although at lower frequencies and with a reduced IgG/IgA isotype ratio. Functional spike-, S1 subunit of the spike protein- (S1-), and RBD-specific recall was also detectable by enzyme-linked immune absorbent spot (ELISPOT) assay in some individuals who had lost nAbs, but was significantly impaired in the elderly. Our findings demonstrate that a reserve of SARS-CoV-2-specific MBCs persists beyond the loss of nAbs but highlight the need for careful monitoring of functional defects in spike- and RBD-specific B cell immunity in the elderly.


Subject(s)
Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/immunology , Immunologic Memory , Memory B Cells/immunology , SARS-CoV-2/immunology , COVID-19/epidemiology , Female , Humans , Immunoglobulin Class Switching , Male , Spike Glycoprotein, Coronavirus/immunology
10.
Lancet Healthy Longev ; 2(12): e811-e819, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1541059

ABSTRACT

BACKGROUND: Understanding the duration of protection and risk of reinfection after natural infection is crucial to planning COVID-19 vaccination for at-risk groups, including care home residents, particularly with the emergence of more transmissible variants. We report on the duration, neutralising activity, and protection against the alpha variant of previous SARS-CoV-2 infection in care home residents and staff infected more than 6 months previously. METHODS: We did this prospective observational cohort surveillance in 13 care homes in Greater London, England. All staff and residents were included. Staff and residents had regular nose and throat screening for SARS-CoV-2 by RT-PCR according to national guidelines, with ad hoc testing of symptomatic individuals. From January, 2021, antigen lateral flow devices were also used, but positive tests still required RT-PCR confirmation. Staff members took the swab samples for themselves and the residents. The primary outcome was SARS-CoV-2 RT-PCR positive primary infection or reinfection in previously infected individuals, as determined by previous serological testing and screening or diagnostic RT-PCR results. Poisson regression and Cox proportional hazards models were used to estimate protective effectiveness of previous exposure. SARS-CoV-2 spike, nucleoprotein, and neutralising antibodies were assessed at multiple timepoints as part of the longitudinal follow-up. FINDINGS: Between April 10 and Aug 3, 2020, we recruited and tested 1625 individuals (933 staff and 692 residents). 248 participants were lost to follow-up (123 staff and 125 residents) and 1377 participants were included in the follow-up period to Jan 31, 2021 (810 staff and 567 residents). There were 23 reinfections (ten confirmed, eight probable, five possible) in 656 previously infected individuals (366 staff and 290 residents), compared with 165 primary infections in 721 susceptible individuals (444 staff and 277 residents). Those with confirmed reinfections had no or low neutralising antibody concentration before reinfection, with boosting of titres after reinfection. Kinetics of binding and neutralising antibodies were similar in older residents and younger staff. INTERPRETATION: SARS-CoV-2 reinfections were rare in older residents and younger staff. Protection from SARS-CoV-2 was sustained for longer than 9 months, including against the alpha variant. Reinfection was associated with no or low neutralising antibody before reinfection, but significant boosting occurred on reinfection. FUNDING: Public Health England.

11.
Sexually Transmitted Infections ; 97(SUPPL 1):A2, 2021.
Article in English | EMBASE | ID: covidwho-1379629

ABSTRACT

This presentation will honor the distinguished career of Julius Schachter, PhD, whose untimely passing due to COVID-19 in December 2020 left a major gap in the STD/HIV field. We will review the career highlights of our eminent colleague in the field of chlamydia microbiology, novel diagnostics, epidemiology, and their application to national and international program policies for chlamydia prevention.

12.
Lancet Reg Health Eur ; 3: 100038, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1192394

ABSTRACT

BACKGROUND: Care homes have been disproportionately affected by the COVID-19 pandemic. We investigated the potential role of asymptomatic infection and silent transmission in London care homes that reported no cases of COVID-19 during the first wave of the pandemic. METHODS: Five care homes with no cases and two care homes reporting a single case of COVID-19 (non-outbreak homes) were investigated with nasal swabbing for SARS-CoV-2 RT-PCR and serology for SARS-CoV-2 antibodies five weeks later. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. Serology results were compared with those of six care homes with recognised outbreaks. FINDINGS: Across seven non-outbreak homes, 718 (387 staff, 331 residents) individuals had a nasal swab and 651 (386 staff, 265 residents) had follow-up serology. Sixteen individuals (13 residents, 3 staff) in five care homes with no reported cases were RT-PCR positive (care home positivity rates, 0 to 7.6%) compared to 13 individuals (3.0 and 10.8% positivity) in two homes reporting a single case.Seropositivity across these seven homes varied between 10.7-56.5%, with four exceeding community seroprevalence in London (14.8%). Seropositivity rates for staff and residents correlated significantly (rs 0.84, [95% CI 0.51-0.95] p <0.001) across the 13 homes. WGS identified multiple introductions into some homes and silent transmission of a single lineage between staff and residents in one home. INTERPRETATION: We found high rates of asymptomatic infection and transmission even in care homes with no COVID-19 cases. The higher seropositivity rates compared to RT-PCR positivity highlights the true extent of the silent outbreak. FUNDING: PHE.

13.
Euro Surveill ; 26(5)2021 02.
Article in English | MEDLINE | ID: covidwho-1067625

ABSTRACT

Two London care homes experienced a second COVID-19 outbreak, with 29/209 (13.9%) SARS-CoV-2 RT-PCR-positive cases (16/103 residents, 13/106 staff). In those with prior SARS-CoV-2 exposure, 1/88 (1.1%) individuals (antibody positive: 87; RT-PCR-positive: 1) became PCR-positive compared with 22/73 (30.1%) with confirmed seronegative status. After four months protection offered by prior infection against re-infection was 96.2% (95% confidence interval (CI): 72.7-99.5%) using risk ratios from comparison of proportions and 96.1% (95% CI: 78.8-99.3%) using a penalised logistic regression model.


Subject(s)
Antibodies, Viral/blood , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Nursing Homes/statistics & numerical data , Reinfection/prevention & control , SARS-CoV-2/genetics , Adult , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/immunology , COVID-19 Serological Testing , Female , Humans , London , Male , Middle Aged , Pandemics , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/isolation & purification , Whole Genome Sequencing
16.
Lancet Reg Health Eur ; 2: 100015, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-988715

ABSTRACT

BACKGROUND: Military personnel in enclosed societies are at increased risk of respiratory infections. We investigated an outbreak of Coronavirus Disease 2019 in a London Army barracks early in the pandemic. METHODS: Army personnel, their families and civilians had nasal and throat swabs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by reverse transcriptase -polymerase chain reaction (RT-PCR), virus isolation and whole genome sequencing, along with blood samples for SARS-CoV-2 antibodies. All tests were repeated 36 days later. FINDINGS: During the first visit, 304 (254 Army personnel, 10 family members, 36 civilians, 4 not stated) participated and 24/304 (8%) were SARS-CoV-2 RT-PCR positive. Infectious virus was isolated from 7/24 (29%). Of the 285 who provided a blood sample, 7% (19/285) were antibody positive and 63% (12/19) had neutralising antibodies. Twenty-two (22/34, 64%) individuals with laboratory-confirmed infection were asymptomatic. Nine SARS-CoV-2 RT-PCR positive participants were also antibody positive but those who had neutralising antibodies did not have infectious virus. At the second visit, no new infections were detected, and 13% (25/193) were seropositive, including 52% (13/25) with neutralising antibodies. Risk factors for SARS-CoV-2 antibody positivity included contact with a confirmed case (RR 25.2; 95% CI 14-45), being female (RR 2.5; 95% CI 1.0-6.0) and two-person shared bathroom (RR 2.6; 95% CI 1.1-6.4). INTERPRETATION: We identified high rates of asymptomatic SARS-CoV-2 infection. Public Health control measures can mitigate spread but virus re-introduction from asymptomatic individuals remains a risk. Most seropositive individuals had neutralising antibodies and infectious virus was not recovered from anyone with neutralising antibodies. FUNDING: PHE.

17.
EClinicalMedicine ; 28: 100597, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-912161

ABSTRACT

BACKGROUND: We investigated six London care homes experiencing a COVID-19 outbreak and found high rates of SARS-CoV-2 infection among residents and staff. Here we report follow-up investigations including antibody testing in the same care homes five weeks later. METHODS: Residents and staff in the initial investigation had a repeat nasal swab for SARS-CoV-2 RT-PCR and a blood test for SARS CoV-2 antibodies using ELISA based on SARS-CoV-2 native viral antigens derived from infected cells and virus neutralisation. FINDINGS: Of the 518 residents and staff in the initial investigation, 186/241 (77.2%) surviving residents and 208/254 (81.9%) staff underwent serological testing. Almost all SARS-CoV-2 RT-PCR positive residents and staff were seropositive five weeks later, whether symptomatic (residents 35/35, 100%; staff, 22/22, 100%) or asymptomatic (residents 32/33, 97.0%; staff 21/22, 95.5%). Symptomatic but SARS-CoV-2 RT-PCR negative residents and staff also had high seropositivity rates (residents 23/27, 85.2%; staff 18/21, 85.7%), as did asymptomatic RT-PCR negative individuals (residents 61/91, 67.0%; staff 95/143, 66.4%). Neutralising antibody was detected in 118/132 (89.4%) seropositive individuals and was not associated with age or symptoms. Ten residents (10/79 re-tested, 12.7%) remained RT-PCR positive but with higher RT-PCR cycle threshold values; 7/10 had serological testing and all were seropositive. New infections were detected in three residents and one staff. INTERPRETATION: RT-PCR provides a point prevalence of SARS-CoV-2 infection but significantly underestimates total exposure in outbreak settings. In care homes experiencing large COVID-19 outbreaks, most residents and staff had neutralising SARS-CoV-2 antibodies, which was not associated with age or symptoms. FUNDING: PHE.

18.
Annals of Oncology ; 31:S1006, 2020.
Article in English | EMBASE | ID: covidwho-804110

ABSTRACT

Background: The outbreak of the COVID-19 pandemic has led to unprecedented disruptions to global cancer care delivery. We conducted this multidisciplinary survey to gain insights into the real-life impact of the pandemic as perceived by cancer patients. Methods: Cancer patients at various stages of their cancer journeys were surveyed with a questionnaire constructed by a multidisciplinary panel of oncologists, clinical psychologists, occupational therapists, physiotherapists and dieticians. The 64-question survey covered patient's concerns on cancer care resources, treatment provision and quality, changes in health-seeking behaviour;the impact of social isolation on physical wellbeing and psychological repercussions. Results: 600 cancer patients in Hong Kong were surveyed in May 2020. Preliminary results showed that 70% of respondents related a COVID-19 diagnosis to compromised cancer treatment and outcome. Although only 45% considered hospital attendance as safe, 80% indicated their willingness to attend oncology appointments remained unaffected. 91% of patients stated their decision to receive chemotherapy was not changed;however, 40% would be willing to trade off the efficacy/side-effect profile for an outpatient regimen. Patients also reported compromised physical wellbeing due to social isolation, in particular, deterioration in exercise tolerance & limb power (44%), reduced appetite (29%), worse sleep quality (35%). Interestingly, 59% of pts reported better care support as a result of family spending more time together. Anxiety and depression were reported in 70% and 54% of patients, respectively. In addition, 20 oncologists provided their predictions on changes in pt's health-seeking behaviours under the pandemic. Results showed that they significantly underestimated patients' willingness and preference to keep their scheduled oncology appointments and treatments despite the risk involved. Conclusions: This original survey revealed the breadth and profoundness of the impact of the COVID-19 pandemic as perceived by cancer patients, headlining patients’ care priorities and showing their unmet needs. It should be taken into consideration as we modify the way cancer care is provided during this unsettling period and beyond. Legal entity responsible for the study: The authors. Funding: The Kowloon Central Cluster Research Committee KCC Research Grant 2020/21, Hong Kong (KCC/RC/G/2021-B01). Disclosure: All authors have declared no conflicts of interest.

19.
J Infect ; 81(4): 621-624, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-801950

ABSTRACT

BACKGROUND: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. METHODS: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. RESULTS: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9-4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. CONCLUSIONS: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.


Subject(s)
Coronavirus Infections/epidemiology , Homes for the Aged/statistics & numerical data , Medical Staff/statistics & numerical data , Nursing Homes/statistics & numerical data , Occupational Exposure/adverse effects , Pneumonia, Viral/epidemiology , Betacoronavirus/genetics , COVID-19 , Coronavirus Infections/transmission , England/epidemiology , Genome, Viral/genetics , Humans , Infection Control/methods , London/epidemiology , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2 , Whole Genome Sequencing
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