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1.
PLoS ONE [Electronic Resource] ; 17(12):e0279355, 2022.
Article in English | MEDLINE | ID: covidwho-2197089

ABSTRACT

In 2020, schools in England closed for six months due to COVID-19, resulting in children being home-schooled. There is limited understanding about the impacts of this on children's mental and physical health and their education. Therefore, we explored how families coped with managing these issues during the school closures. We conducted 30 qualitative interviews with parents of children aged 18 years and under (who would usually be in school) between 16 and 21 April 2020. We identified three themes and eight sub-themes that impacted how families coped whilst schools were closed. We found that family dynamics, circumstances, and resources (Theme 1), changes in entertainment activities and physical movement (Theme 2) and worries about the COVID-19 pandemic (Theme 3) impacted how well families were able to cope. A key barrier to coping was struggles with home-schooling (e.g., lack of resources and support from the school). However, parents being more involved in their children's personal development and education were considered a benefit to home-schooling. Managing the lack of entertainment activities and in-person interactions, and additional health worries about loved ones catching COVID-19 were challenges for families. Parents reported adverse behaviour changes in their children, although overall, they reported they were coping well. However, pre-existing social and educational inequalities are at risk of exacerbation. Families with more resources (e.g., parental supervision, access to green space, technology to facilitate home-schooling and no special educational needs) were better able to cope when schools were closed. On balance, however, families appeared to be able to adapt to the schools being closed. We suggest that policy should focus on supporting families to mitigate the widening health and educational gap between families with more and less resources.

2.
Journal of General Internal Medicine ; 37:S463, 2022.
Article in English | EMBASE | ID: covidwho-1995748

ABSTRACT

CASE: A 61-year-old male with self-reported coronary artery disease (CAD), Hypertension, and bipolar disorder who presented to the Emergency Room with dyspnea. STAT chest CT angiography (CTA) was negative for pulmonary embolism but it demonstrated scattered patchy ill-defined bilateral ground-glass opacities concerning for possible atypical viral pneumonia. Basic work-up showed elevated WBC count and lactic acid. He was started on supportive management and empirical Ceftriaxone and Azithromycin. While on the hospital floor, he started to have sinus- tachycardia and hypoxia necessitating escalation in supplemental oxygen delivery modality. He was later transferred to the ICU. Patient's hypoxic respiratory failure was suspected to be an acute process strongly including COVID-19 pneumonia. Acute bacterial insult was also considered as the WBC count was elevated and this consideration discouraged against starting immunosuppressive regimen targeted against possible COVID-19 pneumonia. A repeat CT scan of the chest was ordered to better highlight the pulmonary findings. The study could not be completed as the patient was unable to lie flat and was developing hypoxia. The diastolic blood pressure (DBP) was noted be elevated and STAT chest xray showed flash pulmonary edema. The patient was started on IV diuretics and potent IV antihypertensive medications. He had not seen a physician for a long time and the medical charts were deficient. The patient soon disclosed that he had recently used synthetic form of inhaled cannabinoids and that he had a similar episode after using synthetic inhaled cannabinoids one year prior. In the meantime, the patient tested negative the second time for COVID-19 infection. Taking these new developments into consideration, the suspicion for an infective pulmonary process did not remain very strong. He was started on IV steroids to address possible hypersensitivity pneumonitis which resulted in prompt and drastic improvement in his respiratory status. IMPACT/DISCUSSION: The patient's unknown COVID-19 vaccination status, pulmonary imaging findings, and the sudden respiratory decompensation very strongly supported possible COVID-19 pneumonia. Acute bacterial pneumonia was also on the differential diagnoses list. The patient's active bipolar disorder made history-taking quite challenging. Since the treatment modalities targeted against the possible etiology of his respiratory failure varied greatly, the need for a clinical diagnosis was imperative. CONCLUSION: Medical history-taking is the backbone of medical practice. It has the highest yield when it comes to patient management. Our patient presented with a spectrum that would be applicable to multiple pathological processes but at the end it was a case of hypersensitivity pneumonitis to a known allergen that was complicated by the presence of hypertensive urgency. IV steroid initiation made significant improvement in the patient's respiratory status as evidenced by the promptly decreasing supplemental oxygen need.

3.
Frontiers in Education ; 7:12, 2022.
Article in English | Web of Science | ID: covidwho-1855333

ABSTRACT

This paper addresses an identified gap in research during the COVID-19 pandemic: how the disruption impacted on pupils with special educational needs and disabilities (SEND) attending specialist (i.e., non-mainstream) settings in England. Estimates provided by around 200 special school and college leaders at two timepoints during the pandemic are used to provide overall estimates of the extent to which the pandemic and time spent out of school had on the academic and developmental progress of pupils in these settings. We find that the reported effects are greater than those reported elsewhere for pupils in mainstream settings. In line with research involving the mainstream school population in England, we find that the reported effects on academic and developmental progress were greater for pupils facing economic disadvantage. Additional data from our survey of leaders reveal that the reasons for the reported impact on pupils were: (i) limited access to school or college and the extended periods of non-attendance;(ii) the widespread disruption to the delivery of health and care provision for pupils with complex SEND;(iii) the particular way in which COVID protections and restrictions impacted the curriculum offer in specialist provisions;and (iv) limited digital access, which affected home learning. Looking to post-COVID recovery, special school and college leaders identify an urgent need for tailored support for their communities.

4.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407555
5.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277384

ABSTRACT

Rationale: Coronavirus disease 2019 (COVID-19) is currently the third leading cause of death in the United States. During the Spring of 2020, the Commonwealth of Massachusetts, USA experienced a surge of COVID-19 ICU cases. Many of these patients developed acute renal failure (ARF) requiring renal replacement therapy (RRT) with hemodialysis (HD) or continuous veno-venous hemofiltration (CVVH) which taxed our hospital's supply of equipment and staff. The goal of our study was to identify predictors of mortality in ICU patients requiring RRT in the setting of COVID-19, should rationing of ICU care became necessary. Methods: Between March 2020 and April 2020, we prospectively collected data on patients admitted to the Lahey ICUs with severe COVID-19 who required RRT and assessed patient characteristics and mortality. Results: Thirty ICU patients were identified with severe COVID-19 requiring RRT. Twenty-seven patients (90%) required acute initiation of CVVH, while three (10%) only utilized intermittent HD during their hospitalization. Only ten (33%) survived their hospitalization. No significant difference was found between survivors and patients who died with respect to age, comorbidities (BMI, CKD, HTN, DM, alcohol use, heart disease, malignancy, COPD, asthma) or baseline creatinine. All 30 patients (100%) required mechanical ventilation (MV) and 25 (83%) developed shock requiring vasopressors prior to initiation of RRT. Seventy percent of survivors (7/10) had been on either an ACE-inhibitor (ACEI) or an Angiotensin Receptor Blocker (ARB) prior to hospitalization, compared to only 20% (4/20) who died (p=0.0147) Survivors were treated with hydroxychloroquine (HC) significantly more frequently (10/10 vs 8/20;p=0.0016) and treated with systemic corticosteroids (CS) significantly less frequently (5/10 vs 20/20;p=0.0018) than those who died. There was no difference in survival between those who received Vancomycin or Tocilizumab and those who did not. The median hospital stay was significantly longer for survivors (46 days) than for those who died (19 days;p =0.0003). Conclusion: The need for RRT in ICU patients with COVID-19 was associated with significant mortality (66%) and a significant need for MV (100%) and vasopressors (83%). The use of an ACEI or ARB prior to admission was significantly associated with improved survival, the use of CS was associated with higher mortality, and the use of HC was associated with improved survival. These latter findings go against current theories of COVID pathophysiology and may be a result of the small number of patients in our study.

6.
J Hosp Infect ; 106(3): 536-553, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1023641

ABSTRACT

BACKGROUND: In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM: To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS: A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS: Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS: Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.


Subject(s)
Coronavirus Infections/prevention & control , Decontamination/standards , Equipment Reuse/standards , Guidelines as Topic , Hot Temperature , Respiratory Protective Devices/virology , Ultraviolet Rays , Humans
7.
J Hosp Infect ; 106(1): 163-175, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-716812

ABSTRACT

Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.


Subject(s)
Coronavirus Infections/prevention & control , Disinfection/standards , Equipment Reuse/standards , Guidelines as Topic , Masks/standards , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ultraviolet Rays , Betacoronavirus , COVID-19 , Efficiency , Humans , SARS-CoV-2 , Safety/standards
8.
J Hosp Infect ; 106(3): 504-521, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-709227

ABSTRACT

BACKGROUND: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION: A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.


Subject(s)
Coronavirus Infections/prevention & control , Decontamination/standards , Disinfectants/administration & dosage , Equipment Reuse/standards , Hydrogen Peroxide/administration & dosage , Respiratory Protective Devices/virology , Sodium Hypochlorite/administration & dosage , Guidelines as Topic , Humans , Ultraviolet Rays
9.
Public Health ; 182: 163-169, 2020 May.
Article in English | MEDLINE | ID: covidwho-625063

ABSTRACT

OBJECTIVES: The December 2019 outbreak of coronavirus has once again thrown the vexed issue of quarantine into the spotlight, with many countries asking their citizens to 'self-isolate' if they have potentially come into contact with the infection. However, adhering to quarantine is difficult. Decisions on how to apply quarantine should be based on the best available evidence to increase the likelihood of people adhering to protocols. We conducted a rapid review to identify factors associated with adherence to quarantine during infectious disease outbreaks. STUDY DESIGN: The study design is a rapid evidence review. METHODS: We searched Medline, PsycINFO and Web of Science for published literature on the reasons for and factors associated with adherence to quarantine during an infectious disease outbreak. RESULTS: We found 3163 articles and included 14 in the review. Adherence to quarantine ranged from as little as 0 up to 92.8%. The main factors which influenced or were associated with adherence decisions were the knowledge people had about the disease and quarantine procedure, social norms, perceived benefits of quarantine and perceived risk of the disease, as well as practical issues such as running out of supplies or the financial consequences of being out of work. CONCLUSIONS: People vary in their adherence to quarantine during infectious disease outbreaks. To improve this, public health officials should provide a timely, clear rationale for quarantine and information about protocols; emphasise social norms to encourage this altruistic behaviour; increase the perceived benefit that engaging in quarantine will have on public health; and ensure that sufficient supplies of food, medication and other essentials are provided.


Subject(s)
Coronavirus Infections/prevention & control , Disease Outbreaks , Guideline Adherence , Health Knowledge, Attitudes, Practice , Pneumonia, Viral/prevention & control , Quarantine/psychology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Culture , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Public Health , Social Norms , Sociological Factors , Time Factors
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