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1.
Sci Rep ; 12(1): 5680, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1778625

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the infectious disease COVID-19, which has rapidly become an international pandemic with significant impact on healthcare systems and the global economy. To assist antiviral therapy and vaccine development efforts, we performed a natural history/time course study of SARS-CoV-2 infection in ferrets to characterise and assess the suitability of this animal model. Ten ferrets of each sex were challenged intranasally with 4.64 × 104 TCID50 of SARS-CoV-2 isolate Australia/VIC01/2020 and monitored for clinical disease signs, viral shedding, and tissues collected post-mortem for histopathological and virological assessment at set intervals. We found that SARS-CoV-2 replicated in the upper respiratory tract of ferrets with consistent viral shedding in nasal wash samples and oral swab samples up until day 9. Infectious SARS-CoV-2 was recovered from nasal washes, oral swabs, nasal turbinates, pharynx, and olfactory bulb samples within 3-7 days post-challenge; however, only viral RNA was detected by qRT-PCR in samples collected from the trachea, lung, and parts of the gastrointestinal tract. Viral antigen was seen exclusively in nasal epithelium and associated sloughed cells and draining lymph nodes upon immunohistochemical staining. Due to the absence of clinical signs after viral challenge, our ferret model is appropriate for studying asymptomatic SARS-CoV-2 infections and most suitable for use in vaccine efficacy studies.


Subject(s)
COVID-19 , Ferrets , Animals , Nasal Mucosa , SARS-CoV-2 , Viral Load
2.
Int J Drug Policy ; 103: 103626, 2022 Feb 17.
Article in English | MEDLINE | ID: covidwho-1693691

ABSTRACT

BACKGROUND: The COVID-19 pandemic has greatly exacerbated the United States' overdose crisis. However, the overlapping impacts of COVID-19 and the overdose crisis have not been experienced equally, with unstably housed people who use drugs (PWUD) disproportionately impacted. Amid these changes, there is a need to understand how risk is experienced and managed among unstably housed PWUD to address health and social needs more effectively. METHODS: This project draws on ethnographic research conducted from June 2020 to April 2021 in Rhode Island. Data include 39 in-depth interviews with unstably housed PWUD and approximately 50 h of ethnographic fieldwork conducted alongside street-based outreach workers. RESULTS: COVID-19 risks were primarily contextualized in relation to participants' prior experiences of overdose events and adverse health outcomes. However, participants had varying levels of risk tolerance that were managed in ways that allowed them to reassert control and agency within the uncertainty of overlapping public health crises. Given participants' level of structural vulnerabilities, COVID-19 risk was managed alongside meeting their basic needs to survive. CONCLUSIONS: Findings demonstrate how COVID-related public health measures (e.g., stay-at-home orders, service closures) reinforced participants' structural vulnerabilities in ways that increased their risk of health and social harms. Implementing and scaling up programs that meet the basic needs of individuals, including permanent housing, social supports, and overdose prevention interventions (e.g., supervised consumption sites) is critically needed to address intersecting risks faced by unstably housed PWUD.

6.
NPJ Vaccines ; 5: 96, 2020.
Article in English | MEDLINE | ID: covidwho-1343456

ABSTRACT

The 'D614G' mutation (Aspartate-to-Glycine change at position 614) of the SARS-CoV-2 spike protein has been speculated to adversely affect the efficacy of most vaccines and countermeasures that target this glycoprotein, necessitating frequent vaccine matching. Virus neutralisation assays were performed using sera from ferrets which received two doses of the INO-4800 COVID-19 vaccine, and Australian virus isolates (VIC01, SA01 and VIC31) which either possess or lack this mutation but are otherwise comparable. Through this approach, supported by biomolecular modelling of this mutation and the commonly-associated P314L mutation in the RNA-dependent RNA polymerase, we have shown that there is no experimental evidence to support this speculation. We additionally demonstrate that the putative elastase cleavage site introduced by the D614G mutation is unlikely to be accessible to proteases.

7.
The Lancet Psychiatry ; 8(5):405-415, 2021.
Article in English | APA PsycInfo | ID: covidwho-1340925

ABSTRACT

Background: Parents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes in the prevalence of maternal depression and anxiety symptoms as a result of the COVID-19 pandemic over time and at the individual level. Methods: In this longitudinal observational study, women who took part in the All Our Families pregnancy cohort in Canada were invited to complete a COVID-19 impact survey between May 20 and July 15, 2020. Women who had not agreed to additional research, had discontinued, were lost to follow-up, or who were not contactable via email were excluded. Maternal depression and anxiety symptoms during the COVID-19 pandemic were compared with three previous estimates collected at 3, 5, and 8-year timepoints (between April, 2012, and October, 2019). Depression symptoms were assessed using the 10-item Center for Epidemiological Studies Depression scale and anxiety symptoms were assessed using the short form of the Spielberger State-Trait Anxiety Inventory. Repeated cross-sectional analyses were done to assess temporal trends and fixed-effects regression models were fitted to assess within-person change over time. Findings: Of the 3387 women included in the All Our Families study, 2445 women were eligible and were invited to participate in the COVID-19 impact study, of whom 1333 consented to participate, and 1301 were included in the longitudinal analysis. At the COVID-19 impact survey timepoint, a higher proportion of mothers had clinically significant depression (35.21%, 95% CI 32.48-38.04) and anxiety symptoms (31.39%, 28.76-34.15) than at all previous data collection timepoints. The mean depression score (8.31, 95% CI 7.97-8.65) and anxiety score (11.90, 11.66-12.13) at the COVID-19 pandemic timepoint were higher than previous data collection waves at the 3-year timepoint (mean depression score 5.05, 4.85-5.25;mean anxiety score 9.51, 9.35-9.66), 5-year timepoint (mean depression score 5.43, 5.20-5.66;mean anxiety score 9.49, 9.33-9.65), and 8-year timepoint (mean depression score 5.79, 5.55-6.02;mean anxiety score 10.26, 10.10-10.42). For the within-person comparisons, depression scores were a mean of 2.30 points (95% CI 1.95-2.65) higher and anxiety scores were a mean of 1.04 points (0.65-1.43) higher at the COVID-19 pandemic timepoint, after controlling for time trends. Larger increases in depression and anxiety symptoms were observed for women who had income disruptions, difficulty balancing home schooling with work responsibilities, and those with difficulty obtaining childcare. White mothers had greater increases in anxiety scores than non-white mothers and health-care workers had smaller increases in depressive symptoms than non-health-care workers. Interpretation: Compared with previous estimates, the prevalence of maternal depression and anxiety among mothers in a Canadian cohort increased during the COVID-19 pandemic. Financial support, childcare provision, and avoiding the closure of schools, might be key priorities for preventing future increases in maternal psychological distress. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

8.
9.
Front Psychiatry ; 12: 597759, 2021.
Article in English | MEDLINE | ID: covidwho-1304615

ABSTRACT

Objectives: Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We will identify risk and protective factors for maternal mental health outcomes using longitudinal data that can inform policy and government resource allocation in future disasters. Methods: Mothers who are currently participating in two longitudinal studies, Alberta Pregnancy Outcomes and Nutrition (APrON; N = 1,800) and All Our Families (AOF: N = 2,534) were eligible to participate. Mothers were invited to complete the baseline COVID-19 Impact Survey (20-30 min) within 4 months of March 15, 2020, which was when the province of Alberta, Canada, implemented school closures and physical-distancing measures to prevent the spread of COVID-19. Mothers were asked to report on their own, their child's and their family's functioning. Mothers were re-surveyed at 6 months after completion of the initial COVID-19 Impact Survey, and will be re-surveyed again at 12 months. Results: Responses from participants in both cohorts will be examined in harmonized analyses as well as separately. Descriptive, multivariable analysis will be undertaken to examine risk and resiliency over time and factors that predict mental health and well-being. Conclusions: This study will provide timely information on the impact of COVID-19 for Albertan families. It will identify risk and protective factors for mental health and well-being among contemporary urban families supported by a publicly funded health care system to inform allocation of resources to support those most vulnerable during a global pandemic.

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11.
CMAJ Open ; 9(2): E548-E555, 2021.
Article in English | MEDLINE | ID: covidwho-1239170

ABSTRACT

BACKGROUND: Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination. METHODS: Participants from the All Our Families pregnancy longitudinal cohort whose children had reached ages 9-12 years were invited in May-June 2020 to complete a survey on the impact of COVID-19. The survey covered topics about the impact of the pandemic and included 2 specific questions on mothers' intentions to vaccinate their child against SARS-CoV-2. Current responses were linked to previously collected data, including infant vaccine uptake. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status and vaccination intention. Qualitative responses regarding factors affecting decision-making were analyzed thematically. RESULTS: The response rate was 53.8% (1321/2455). A minority of children of participants had partial or no vaccinations at age 2 (n = 200, 15.1%). A total of 60.4% of mothers (n = 798) intended to vaccinate their children with the SARS-CoV-2 vaccine, 8.6% (n = 113) did not intend to vaccinate and 31.0% (n = 410) were unsure. Lower education, lower income and incomplete vaccination history were inversely associated with intention to vaccinate. Thematic analysis of qualitative responses showed 10 themes, including safety and efficacy, long-term effects and a rushed process. INTERPRETATION: Within a cohort with historically high infant vaccination, a third of mothers remained unsure about vaccinating their children against SARS-CoV-2. Given the many uncertainties about future SARS-CoV-2 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Intention , Mothers/psychology , Vaccination/psychology , Adult , Age Factors , COVID-19 Vaccines/adverse effects , Canada , Child , Educational Status , Female , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Income , Marital Status , Middle Aged , Regression Analysis , SARS-CoV-2
12.
NPJ Vaccines ; 6(1): 67, 2021 May 10.
Article in English | MEDLINE | ID: covidwho-1223093

ABSTRACT

Vaccines against SARS-CoV-2 are likely to be critical in the management of the ongoing pandemic. A number of candidates are in Phase III human clinical trials, including ChAdOx1 nCoV-19 (AZD1222), a replication-deficient chimpanzee adenovirus-vectored vaccine candidate. In preclinical trials, the efficacy of ChAdOx1 nCoV-19 against SARS-CoV-2 challenge was evaluated in a ferret model of infection. Groups of ferrets received either prime-only or prime-boost administration of ChAdOx1 nCoV-19 via the intramuscular or intranasal route. All ChAdOx1 nCoV-19 administration combinations resulted in significant reductions in viral loads in nasal-wash and oral swab samples. No vaccine-associated adverse events were observed associated with the ChAdOx1 nCoV-19 candidate, with the data from this study suggesting it could be an effective and safe vaccine against COVID-19. Our study also indicates the potential for intranasal administration as a way to further improve the efficacy of this leading vaccine candidate.

13.
BMJ Supportive & Palliative Care ; 11(Suppl 1):A26-A27, 2021.
Article in English | ProQuest Central | ID: covidwho-1138425

ABSTRACT

BackgroundIn many countries the COVID-19 pandemic has resulted in unwelcome news being delivered by staff over the telephone as hospital visiting by relatives has been restricted. This includes having to communicate patients have died or are critically unwell. We wanted to increase nursing and medical staff confidence and skills in communicating by telephone, in time critical situations to relatives in the emergency department.MethodsA blended learning package was created. This consisted of a bespoke 15-minute eLearning session and a 1-hour facilitated role-play session. Two simulated telephone calls to a professional actor, posing as the relative were undertaken. The calls simulated realistic time critical telephone conversations including obtaining crucial medical information, conveying news of an acutely unstable patient. A second call to the relative involved breaking the news that the patient had died. Following this the actor gave feedback to the caller focusing on the experience of a relative during these conversations with observers joining as a learning conversation. Group participants reflected on their learning during the session and in a follow up questionnaire. The actors were paid for by the department.Results61 staff received this session over the months May and June 2020. Key new elements specific to telephone conversations were explored. During the learning conversation, learners discovered important ideas for framing the conversation, checking the recipient’s welfare, and how to open and close the conversations.ConclusionThe unique feedback from the simulated relative’s perspective has enabled us to deliver a learning package that helps to prepare learners to deliver unwelcome news over the telephone in time critical situations. Further work will look at the clinical impact of this project.

16.
Lancet Microbe ; 1(4): e141-e142, 2020 08.
Article in English | MEDLINE | ID: covidwho-1087368
17.
BMJ Open ; 11(1): e043418, 2021 01 25.
Article in English | MEDLINE | ID: covidwho-1048683

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has resulted in many countries applying restrictive measures, such as lockdown, to contain and prevent further spread. The psychological impact of lockdown and working as a healthcare worker on the frontline has been chronicled in studies pertaining to previous infectious disease pandemics that have reported the presence of depressive symptoms, anxiety, insomnia, and post-traumatic stress symptoms. Potentially linked to psychological well-being and not yet studied is the possibility that lockdown and working on the frontline of the pandemic are associated with perceptions of coercion. METHODS AND ANALYSIS: The present study aimed to examine perceived coercion in those who have experienced COVID-19-related lockdown and/or worked as a frontline healthcare worker across three European countries. It aimed to describe how such perceptions may impact on psychological well-being, coping and post-traumatic growth. It will employ an explanatory mixed-methods research methodology consisting of an online survey and online asynchronous virtual focus groups (AVFGs) and individual interviews. χ2 tests and analyses of variance will be used to examine whether participants from different countries differ according to demographic factors, whether there are differences between cohorts on perceived coercion, depression, anxiety and post-traumatic growth scores. The relationship between coercion and symptoms of distress will be assessed using multiple regression. Both the AVFGs and the narrative interviews will be analysed using thematic narrative analysis. ETHICS AND DISSEMINATION: The study has been approved by University College London's Research Ethics Committee under Project ID Number 7335/004. Results will be disseminated by means of peer-reviewed publications and at national and/or international conferences.


Subject(s)
COVID-19/psychology , Coercion , Health Personnel/psychology , Pandemics , Perception , Adaptation, Psychological , COVID-19/epidemiology , Europe/epidemiology , Focus Groups , Humans , Mental Health , Physical Distancing , Psychological Distress , SARS-CoV-2 , Stress, Psychological
18.
J Crit Care ; 62: 138-144, 2021 04.
Article in English | MEDLINE | ID: covidwho-966092

ABSTRACT

BACKGROUND: Despite growing controversies around Hydroxychloroquine's effectiveness, the drug is still widely prescribed by clinicians to treat COVID19 patients. Therapeutic judgment under uncertainty and imperfect information may be influenced by personal preference, whereby individuals, to confirm a-priori beliefs, may propose drugs without knowing the clinical benefit. To estimate this disconnect between available evidence and prescribing behavior, we created a Bayesian model analyzing a-priori optimistic belief of physicians in Hydroxychloroquine's effectiveness. METHODOLOGY: We created a Bayesian model to simulate the impact of different a-priori beliefs related to Hydroxychloroquine's effectiveness on clinical and economic outcome. RESULTS: Our hypothetical results indicate no significant difference in treatment effect (combined survival benefit and harm) up to a presumed drug's effectiveness level of 20%, with younger individuals being negatively affected by the treatment (RR 0.82, 0.55-1.2; (0.95 (1.1) % expected adverse events versus 0.05 (0.98) % expected death prevented). Simulated cost data indicate overall hospital cost (medicine, hospital stay, complication) of 18.361,41€ per hospitalized patient receiving Hydroxychloroquine treatment. CONCLUSION: Off-label use of Hydroxychloroquine needs a rational, objective and datadriven evaluation, as personal preferences may be flawed and cause harm to patients and to society.


Subject(s)
COVID-19 , Physicians , Bayes Theorem , COVID-19/drug therapy , Cost-Benefit Analysis , Humans , Hydroxychloroquine/adverse effects , SARS-CoV-2 , Treatment Outcome
19.
BMJ Simulation & Technology Enhanced Learning ; 6(Suppl 1):A59-A60, 2020.
Article in English | ProQuest Central | ID: covidwho-919140

ABSTRACT

IntroductionThe global Pandemic of COVID-19 has seen many challenges world-wide in health care. Due to restrictions of visitors to many United Kingdom hospitals, this has led to bad-news conversations having to occur by telephone. These conversations include everything from telling a relative that their loved one has died through to discussing do – not resuscitate decisions. Through an anonymous training needs analysis of the health care professionals within our Emergency Department (ED), we discovered that communicating bad news over the telephone was something people wanted further training on.MethodsA training needs analysis identified the need for training. A blended learning package was created. This consisted of a 15-minute eLearning session and a 1-hour facilitated role-play session, with an accompanying facilitator pack suitable for staff who were novice educators but experienced in breaking bad news as clinicians. The role-play session used professional actors as the relative, who were also trained in giving feedback. 2 learners made phone calls and up to 8 observers actively participated via a facilitated discussion. Immediate and delayed feedback were obtained.Results61 people were involved in this pilot educational project from May to June 2020. 23 people participated as the call maker and the remainder as observers. All participants reported that their confidence and knowledge had increased. The feedback given from the actor was useful for development. Inexperienced staff were able to learn from more experienced staff.Discussion and ConclusionsBreaking bad news is challenging, but not being able to do it person probably adds an increased level of difficulty. This pilot project has found these simulated calls a really valuable learning experience, for both observers and call makers. We are hoping to role this training out to senior doctors and nurse across our emergency department. With their evaluation helping to develop further scenarios.This short educational package was found to be a useful learning tool in delivering bad news over the telephone. Further work is needed to explore the clinical effectiveness of this project.

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