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1.
Am J Med ; 2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1956061

ABSTRACT

BACKGROUND: We systematically assessed beneficial and harmful effects of monoclonal antibodies for COVID-19 treatment, and prophylaxis in exposed to SARS-CoV-2. METHODS: We searched five engines and three registries until November 3, 2021 for randomized controlled trials evaluating monoclonal antibodies vs. control in hospitalized or non-hospitalized adults with COVID-19, or as prophylaxis. Primary outcomes were all-cause mortality, COVID-19 related death, and serious adverse events; hospitalization for non-hospitalized; and development of symptomatic COVID-19 for prophylaxis. Inverse variance random effects models were used for meta-analyses. GRADE methodology was used to assess certainty of evidence. RESULTS: Twenty-seven randomized controlled trials were included: 20 in hospitalized (n=8253), five in non-hospitalized (n=2922), and two in prophylaxis (n=2680). In hospitalized patients, monoclonal antibodies slightly reduced mechanical ventilation (relative risk [RR] 0.74, 95%CI 0.60-0.9, I2=20%, low certainty of evidence) and bacteremia (RR 0.77, 95%CI 0.64-0.92, I2=7%, low certainty of evidence); evidence was very uncertain about the effect on adverse events (RR 1.31, 95%CI 1.02-1.67, I2=77%, very low certainty of evidence). In non-hospitalized patients, monoclonal antibodies reduced hospitalizations (RR 0.30, 95%CI 0.17-0.53, I2=0%, high certainty of evidence) and may slightly reduce serious adverse events (RR 0.47, 95%CI 0.22-1.01, I2=33%, low certainty of evidence). In prophylaxis studies, monoclonal antibodies probably reduced viral load slightly (Mean difference [MD] -0.8 log10, 95%CI -1.21 to -0.39, moderate certainty of evidence). There were no effects on other outcomes. CONCLUSIONS: Monoclonal antibodies had limited effects on most of the outcomes in COVID-19 patients, and when used as prophylaxis. Additional data is needed to determine their efficacy and safety.

2.
Journal of Clinical Urology ; 15(1):5, 2022.
Article in English | EMBASE | ID: covidwho-1957019

ABSTRACT

Introduction: The COVID19 pandemic has led to unprecedented pressures on theatre waiting lists. The numbers of patients requiring regular ureteric stent changes under general anesthetic (GA) can be significant. We performed a regional study of these patients to assess;i) suitability for procedures under local anaesthetic (LA) and ii) outcomes for those then having LA rather than GA procedures. Patients and Methods: A retrospective cohort study from 3 urology centres was performed. Feasibility criteria for transition to LA stent change was determined on;comorbidities, indication for stent placement and operative factors. 2 centres subsequently initiated regular out-of-theatre LA stent change lists and outcomes were reviewed. Results: 216 cases were included. Median age was 68 and sex ratio 1:1 (M:F). Commonest indications for indwelling stents included benign strictures (37%), non-urological malignancy (24.1%) and urological malignancy (22.2%). 34 patients were suitable for/awaiting definitive procedures. Average number of changes was 2.4/year with 49% of patients being ASA3 or higher. LA stent changes were deemed feasible in 70 patients. 63 procedures were performed under LA with a 98% success rate. Complications (30d) included stent migration (2), haematuria (2) and infection (1). Conclusion: Innovation is required to deal with significant COVID-19 related problems. LA ureteric stent changes are safe and tolerable in appropriately selected patients. Performing these outside of the theatre environment increases capacity on surgical waiting lists. Patient benefits include reduced risks of multiple GA procedures in elderly and co-morbid patients. This data encourages expansion of this initiative.

3.
Arch Med Sci ; 18(4): 939-948, 2022.
Article in English | MEDLINE | ID: covidwho-1911939

ABSTRACT

Introduction: No early treatment intervention for COVID-19 has proven effective to date. We systematically reviewed the efficacy of hydroxychloroquine as early treatment for COVID-19. Material and methods: Randomized controlled trials (RCTs) evaluating hydroxychloroquine for early treatment of COVID-19 were searched in five engines and preprint websites until September 14, 2021. Primary outcomes were hospitalization and all-cause mortality. Secondary outcomes included COVID-19 symptom resolution, viral clearance, and adverse events. Inverse variance random-effects meta-analyses were performed and quality of evidence (QoE) per outcome was assessed with GRADE methods. Results: Five RCTs (n = 1848) were included. The comparator was placebo in four RCTs and usual care in one RCT. The RCTs used hydroxychloroquine total doses between 1,600 and 4,400 mg and had follow-up times between 14 and 90 days. Compared to the controls, early treatment with hydroxychloroquine did not reduce hospitalizations (RR = 0.80, 95% CI: 0.47-1.36, I 2 = 2%, 5 RCTs, low QoE), all-cause mortality (RR = 0.77, 95% CI: 0.16-3.68, I 2 = 0%, 5 RCTs, very low QoE), symptom resolution (RR = 0.94, 95% CI: 0.77-1.16, I 2 = 71%, 3 RCTs, low QoE) or viral clearance at 14 days (RR = 1.02, 95% CI: 0.82-1.27, I 2 = 65%, 2 RCTs, low QoE). There was a larger non-significant increase of adverse events with hydroxychloroquine vs. controls (RR = 2.17, 95% CI: 0.86-5.45, I 2 = 92%, 5 RCTs, very low QoE). Conclusions: Hydroxychloroquine was not efficacious as early treatment for COVID-19 infections in RCTs with low to very low quality of evidence for all outcomes. More RCTs are needed to elucidate the efficacy of hydroxychloroquine as early treatment intervention.

4.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880340
5.
PLoS One ; 17(6): e0269368, 2022.
Article in English | MEDLINE | ID: covidwho-1879321

ABSTRACT

INTRODUCTION: We systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients. METHODS: Five electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology. RESULTS: Nine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81-0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44-1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71-0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts. CONCLUSIONS: In comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients.


Subject(s)
COVID-19 , Neutropenia , Adult , Antibodies, Monoclonal, Humanized/adverse effects , COVID-19/drug therapy , Humans , Neutropenia/drug therapy , Randomized Controlled Trials as Topic
6.
Journal of the American College of Cardiology ; 79(9):2331-2331, 2022.
Article in English | Web of Science | ID: covidwho-1849434
7.
Open Forum Infectious Diseases ; 8(SUPPL 1):S261, 2021.
Article in English | EMBASE | ID: covidwho-1746683

ABSTRACT

Background. Fungal infections have been identified with or following SARSCoV-2 infection, most commonly COVID associated pulmonary aspergillosis. Cryptococcus species are ubiquitous in the environment and the third most common invasive fungal infection following Solid Organ Transplant (SOT). We describe four cases of concurrent or subsequent cryptococcal infection within 90 days following COVID-19 infection. Methods. We conducted a retrospective study of patients presenting with proven cryptococcosis either concurrently or within 90 days following COVID-19 diagnosis. Cases were identified March 2020 through May 2021. All were seen at the University of Alabama in Birmingham, a regional referral and comprehensive transplant center. Exemption for this review was approved by our IRB. Results. Four cases were identified, all were SOT recipients. Case details are provided in Table 1. No patients required ICU level care at any point. COVID-19 treatment included 10 days of increased steroids for 3 patients, remdesivir for 2, and 1 received no treatment for COVID-19. In contrast to the typical time-course for cryptococcal infection post-SOT (median time approx. 500 days post-transplant), three patients were greater than 2 years post-transplant and were without rejection or recent changes in immunosuppression. Patient 1 was less than 6 months post liver-kidney transplant and was diagnosed at time of admission with concurrent COVID-19 and cryptococcal pneumonia. Infection was disseminated in the other 3 cases including positive blood cultures in 2 patients and cryptococcal meningitis (CM) in 2 patients. CM cases presented later following COVID-19 and had the longest delay between symptom onset (headache, neurologic symptoms) and CM diagnosis. One patient had CM 8 years prior, but had done extremely well off fluconazole for over 6 years prior to this recurrence. All patients are doing well at most recent follow-up evaluations. Conclusion. We describe the first case series with a temporal association between SARS-CoV-2 infection and cryptococcosis. All cases were immunocompromised due to SOT. Some symptoms were attributed to post-COVID syndrome leading to significant delays in diagnosis for those patietns, highlighting the importance of considering this association for at-risk patients.

8.
Infectious Diseases in Clinical Practice ; 30(2), 2022.
Article in English | EMBASE | ID: covidwho-1691763

ABSTRACT

During the current pandemic, the 2019 novel coronavirus (SARS-CoV-2) has quickly moved to the top of the list of potential causes of acute respiratory distress syndrome (ARDS) in patients presenting to the hospital. Potential COVID-19 infections should continue to be quickly identified and treated when indicated, but it is important that we not forget about the other potential causes of ARDS. In this case series, we will discuss 3 cases of ARDS that were passed off as likely SARS-CoV-2 infections but were all discovered to be negative for COVID-19. This highlights the importance of maintaining a thorough history and physical examination during the pandemic to identify the other causes of ARDS and avoid the negative effects of frequency bias.

9.
J Am Pharm Assoc (2003) ; 62(1): 247-252, 2022.
Article in English | MEDLINE | ID: covidwho-1604626

ABSTRACT

BACKGROUND: On December 7, 2020, the Acting Commissioner of the Connecticut Department of Public Health (DPH) issued an order authorizing eligible health professionals to administer coronavirus disease (COVID-19) vaccines provided they complete a vaccination training program. The University of Connecticut (UConn) School of Pharmacy was approached to collaborate with DPH to create a certification program to meet the needs of this order. OBJECTIVES: To use a unique, pharmacist-led practice model to increase the number of competent vaccinators to administer the COVID-19 vaccine and to reduce vaccine hesitancy with timely vaccine information. PRACTICE DESCRIPTION: A didactic and in-person training program was developed, with an evaluation completed by a vaccination-certified pharmacist. In addition, faculty members, staff, and students developed short videos answering questions about COVID-19 vaccines. PRACTICE INNOVATION: We are aware of no other such programs using pharmacists and student pharmacists as primary creators of training and certification of health professionals to administer the COVID-19 vaccine. EVALUATION METHODS: Success was gauged by the rapid increase in the number of eligible health professionals who completed the developed training program and became certified as COVID-19 vaccinators. When addressing vaccine hesitancy, success was defined by the number of videos created and the number of views and likes the videos received. RESULTS: As of April 30, 2021, 1834 health professionals registered to administer the COVID-19 vaccine. A total of 1195 (65%) participants completed the online training developed by pharmacists, and 872 participants (48%) attended pharmacist-led, in-person competencies. As of July 29, 2021, efforts resulted in 14,972 views and 257 "Likes" for 79 videos promoted through social media platforms. CONCLUSION: A partnership between the Connecticut DPH and the UConn School of Pharmacy allowed the rapid increase in capacity to administer the COVID-19 vaccine to citizens of Connecticut. Patients are receptive to accessing health information that pharmacists create on social media.


Subject(s)
COVID-19 Vaccines , COVID-19 , Connecticut , Humans , Pharmacists , SARS-CoV-2 , Vaccination
10.
American Journal of Gastroenterology ; 116(SUPPL):S604, 2021.
Article in English | EMBASE | ID: covidwho-1534741

ABSTRACT

Introduction: Occupational noise exposure can lead to noise-induced hearing loss (NHL) with serious health and economic consequences for workers. The Center for Disease Control and Prevention and the National Institute for Occupational Safety and Health (NIOSH) have published a recommended exposure limit of 85-decibels (dB) for workplace exposure to prevent NHL. Despite these recommendations for workplace noise exposure, little is known about the noise levels generated during gastrointestinal (GI) endoscopy. We aimed to investigate the noise generated by suction during GI endoscopy. Methods: Sound levels were measured using the “NIOSH Sound Level Meter” smart phone application. The noise generated from an adult colonoscope (Olympus HQ190) at various levels of suction were measured using Neptune 3 (Stryker, Kalamazoo, MI) mobile surgical suction device (SSD) that allows a wide range of suction pressure levels versus “traditional” wall suction (WS). Measurements were obtained as average levels over a 30-second interval in a quiet, outpatient ambulatory endoscopy room. Noise measurements were obtained at various positions within the room (endoscopist, nurse/ technician) as well as next to the endoscope suction button. The measurements were obtained with the endoscopist applying no suction, partial suction and complete suction. Results: With the SSD, sound levels increased as suction pressure increased. The highest sound levels were generated when no endoscopic suction was applied. None of the measurements exceeded recommended exposure limits set by the NIOSH (Table 1). With pressure levels set at 200 mmHg (traditional wall suction maximums) sound levels at the endoscopist for SSD and WS were 54.3 dB and 47.1 dB, respectively, e.g. more than 7 times louder. Conclusion: Little is known about the occupational safety of noise levels in endoscopy nor the contribution suction contributes. In this study, noise levels did not exceed the recommended exposure limit set by the NIOSH. However, SSD generates significantly more noise than WS at the same pressure levels. While these levels may not constitute an occupational hazard, they make communication more difficult especially in the COVID era of enhanced PPE (e.g. face shield, N95). The techniques developed during the study offer a simple process that can be implemented in any GI endoscopy suite to assess the contributions of suction to workplace noise..

11.
Chest ; 160(4):A687, 2021.
Article in English | EMBASE | ID: covidwho-1458487

ABSTRACT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: SARS-CoV-2 (COVID-19) is a rapidly spreading virus that has resulted in a pandemic. Individuals impacted have varying symptoms and disease courses, ranging from asymptomatic carriers to severe respiratory illness. Pneumomediastinum, a rare complication of COVID-19 (where air is present in the mediastinum with or without pneumothorax) is presented here. CASE PRESENTATION: Our case is that of a 59-year-old man who presented to the emergency department with complaints of fever and chills for five days. His past medical history included hypertension, type 2 diabetes mellitus and hyperlipidemia. He endorsed associated dry cough, decreased appetite and shortness of breath. He denied recent travel or exposure to COVID-19. Initially the patient was hemodynamically stable, but hypoxic with oxygen saturation of 82%, requiring 4L nasal cannula (NC) – with improvement to 93-95%. Chest imaging revealed low lung volumes and patchy bilateral opacities. COVID-19 PCR was positive. He was admitted to the medical floor with acute COVID-19 pneumonia. He was treated with dexamethasone and remdesivir, and was encouraged to self-prone. Due to worsening hypoxia, he required a non-rebreather mask. Daily chest x rays were obtained, and on hospital day seven, imaging revealed air around the neck, suggesting pneumomediastinum without pneumothorax. CT chest and neck showed significant air dissecting up from the superior mediastinum, extending through the neck soft tissues bilaterally, confirming acute pneumomediastinum. With further pulmonary decompensation and respiratory failure, he required intubation and mechanical ventilation. A low PEEP strategy was employed to prevent worsening pneumomediastinum. In the subsequent week, although his pneumomediastinum resolved, the patient unfortunately developed ARDS and passed away. DISCUSSION: This presentation of acute pneumomediastinum in the setting of COVID-19 is an uncommon complication of the viral illness. Diffuse alveolar damage and/or complication of mechanical ventilation have been speculated to be possible causes. Pneumomediastinum is typically a benign diagnosis, but can sometimes progress to malignant mediastinum, where air compresses the trachea or venous return, which can in turn present as cardiac tamponade. In these cases, chest tube, VATS or thoracotomy may be indicated.1 CONCLUSIONS: Cases of pneumomediastinum in patients infected with COVID-19 are limited, hence its impact on worsening illness or outcome cannot be determined. Recommendations continue to focus on close monitoring with daily chest imaging. Should intubation be required, it is recommended to maintain a needle at bedside for needle thoracostomy in the event acute pneumothorax occurs.2 A low tidal volume, low PEEP strategy is also encouraged to mitigate risk of further barotrauma.3 Early paralysis may be beneficial to prevent coughing or ventilator dyssynchrony. REFERENCE #1: Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis. 2015;7(Suppl 1):S44-S49. doi:10.3978/j.issn.2072-1439.2015.01.11 REFERENCE #2: Mousa S, Edriss H. Pneumomediastinum secondary to invasive and non-invasive mechanical ventilation. The Southwest Respiratory and Critical Care Chronicles. 2019;7(27), 36-42. https://doi.org/10.12746/swrccc.v7i27.524 REFERENCE #3: Wali A, Rizzo V, Bille A, Routledge T, Chambers A. Pneumomediastinum following intubation in COVID-19 patients: a case series. Anaesthesia. 2020;75: 1076-1081. https://doi.org/10.1111/anae.15113 DISCLOSURES: No relevant relationships by James McGee, source=Web Response No relevant relationships by Cilian White, source=Web Response No relevant relationships by Momina Zaman, source=Web Response

12.
JACCP Journal of the American College of Clinical Pharmacy ; 4(9):1223-1224, 2021.
Article in English | EMBASE | ID: covidwho-1445837

ABSTRACT

Introduction: To stop the spread of COVID-19, Emergency Use Authorization (EUA) vaccines from Moderna and Pfizer-BioNtech were granted in December 2020. Due to the vaccines being fasttracked, the safety profiles are being closely studied, including fatal adverse drug events. Research Question or Hypothesis: The purpose of this study is to identify the specific patient characteristics of those who died after receiving either the Moderna or Pfizer-BioNtech COVID-19 vaccine through the Vaccine Adverse Event Reporting System (VAERS). Study Design: Analysis of 717 patients who died after COVID-19 vaccination in the U.S. Methods: Using the VAERS, data was extracted from December 2020 to February 2021 on patients that died after receiving either the Moderna or Pfizer-BioNtech vaccine. Information collected included: vaccine manufacturer, patient's age, sex, state of vaccine administration, dose received, date vaccinated, date of symptoms onset, date of death, symptoms, adverse drug event (ADE) description, medication history, allergies, current medications, and illnesses. The patients were then categorized per ADEs that possibly related to death. Results: A total of 568 patients were included ranging from ages 23 to 108 years old, with a median age of 78.5 and mean age of 77.3. Of the patients who died, 56% were male, and 44% were female. The top three adverse effect categories were respiratory (23.8%), cardiac (21.3%), and fatigue (10.9%). The reported deaths were similar after receiving either the Moderna vaccine (51.1%) or the Pfizer-BioNtech vaccine (48.9%). Eighty percent of patients died after receiving the first dose, and 20% died after receiving the second dose. Conclusion: Based on the first three months of VAERS data, fatality post-vaccination presented more in male elderly patients. Respiratory and cardiac events were the most common adverse events in this study;however, these were not prominent in manufacturer data. Further investigation would be needed to establish a direct correlation between the Moderna and Pfizer-BioNtech COVID-19 vaccines and death.

13.
J Clin Pharmacol ; 61 Suppl 2: S129-S141, 2021 08.
Article in English | MEDLINE | ID: covidwho-1355875

ABSTRACT

Use of US Food and Drug Administration-approved substances of abuse has innate risks due to pharmacologic and pharmacokinetic properties of the medications, but the risk when using nonapproved drug products is much greater. Unbeknownst to the user, the dose of active ingredients in substances of abuse can vary substantially between different products because of manufacturing practices or improper storage. Even naturally occurring substances of abuse can have extensive dosage variability because of effects of the growing season and conditions, or differences in harvesting, storage, or manufacture of the finished products. Many illicit substances are adulterated, to make up for intentional underdosing or to enhance the effect of the intended active ingredient. These adulterants can be dangerous and produce direct cardiovascular, neurologic, hematologic, or dermatologic reactions or obscure adverse effects. Finally, an illicit substance can be contaminated or substituted for another one during its manufacture, leading to differences in adverse events, adverse event severity, or the drug interaction profile. Substances can be contaminated with microbes that induce infections or heavy metals that can damage organs or cause cancer. This milieu of undisclosed substances can also induce drug interactions. For reasons that are discussed, individuals who use substances of abuse are at increased risk of morbidity or mortality if they develop coronavirus disease 2019. Health professionals who treat patients with acute, urgent events associated with substances of abuse, or those treating the chronic manifestations of addiction, need to appreciate the complex and variable composition of substances of abuse and their potential health effects.


Subject(s)
Drug-Related Side Effects and Adverse Reactions/complications , Illicit Drugs/adverse effects , Substance-Related Disorders/complications , COVID-19/mortality , Drug Interactions/physiology , Drug-Related Side Effects and Adverse Reactions/mortality , Humans , Substance-Related Disorders/mortality , United States , United States Food and Drug Administration
14.
Australasian Journal on Ageing ; 40:16-16, 2021.
Article in English | Web of Science | ID: covidwho-1244461
15.
Pediatrics ; 147(3):985-986, 2021.
Article in English | EMBASE | ID: covidwho-1177812

ABSTRACT

Background: Telehealth is a novel way to provide care to patients and families and may be especiallyimportant for families with transportation challenges. The COVID-19 pandemic with social distancingrequirements further accelerated the need for the utilization and expansion of telehealth services. Objective:To evaluate the feasibility of rapidly scaling primary-care telehealth and its impact on families' location of careand associated transportation costs. Methods: A retrospective study was conducted at a large, urban,academic primary care center consisting of 6 primary care sites, with approximately 85% of patients coveredby Medicaid. In February 2020, just prior to the COVID-19 pandemic, telehealth was launched for routinefollow-up of chronic medical conditions (e.g., ADHD, asthma) and acute complaints (e.g., rashes) two half-daysper week. Due to COVID-19, rapid escalation of telehealth was necessary and during these telehealth visits,families were asked the location of care they would have chosen if telehealth was not available (in-personprimary care, Emergency Department (ED), Urgent Care (UC), or opt for no care). Miles saved (measured bydistance from family residence zip code to the hospital main campus where the ED, UC, and most primary care sites are located) and cost saved (as measured by federal reimbursement amounts for mileage) weredetermined from demographic information in the electronic health record. Results: Five physicians trained anadditional 16 clinicians over 2 weeks, providing the ability to expand telehealth to six days per week. FromFebruary-March 2020, 245 unique telehealth encounters were completed. Providers asked 60% (n=147) offamilies where they would have sought in-person care if telehealth was not available, with the largest percent(68.7% (n= 101)) indicating a primary care visit. In addition, 14.2% (n= 21) of families reported intent to visit theED, 4.8% (n=7) an UC and 12.2% (n=18) would have opted for no care. Regarding savings related to distance toan alternative location of care, families saved an average of 16 miles ($9.30) for an in-person primary care visit,13 miles ($7.19) for an ED visit, and 11.4 miles ($6.23) for an urgent care visit. Families who would have optedfor no care lived the farthest, with an average 21 miles. A substantial percent of families (19%;n=28) reportedthat they would have sought more costly care options (ED or UC). Conclusion: Rapid scaling of primary carebased telehealth was feasible serving a mostly publically insured population. The majority of families reportedthat without telehealth, they would have sought in-person visits, but those who lived farthest would not havesought care. Telehealth appears to be a cost saving alternative for families and the medical system. Next stepsinclude a trial of social risk and mental health screening during telehealth visits.

16.
Wellcome Open Research ; 5:213, 2020.
Article in English | MEDLINE | ID: covidwho-1175761

ABSTRACT

Background: During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study.

17.
Photochem Photobiol Sci ; 20(1): 1-67, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1103607

ABSTRACT

This assessment by the Environmental Effects Assessment Panel (EEAP) of the United Nations Environment Programme (UNEP) provides the latest scientific update since our most recent comprehensive assessment (Photochemical and Photobiological Sciences, 2019, 18, 595-828). The interactive effects between the stratospheric ozone layer, solar ultraviolet (UV) radiation, and climate change are presented within the framework of the Montreal Protocol and the United Nations Sustainable Development Goals. We address how these global environmental changes affect the atmosphere and air quality; human health; terrestrial and aquatic ecosystems; biogeochemical cycles; and materials used in outdoor construction, solar energy technologies, and fabrics. In many cases, there is a growing influence from changes in seasonality and extreme events due to climate change. Additionally, we assess the transmission and environmental effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the COVID-19 pandemic, in the context of linkages with solar UV radiation and the Montreal Protocol.

19.
Journal of the American College of Cardiology ; 76(17):B94-B94, 2020.
Article in English | Web of Science | ID: covidwho-1001212
20.
PLoS One ; 15(12): e0243705, 2020.
Article in English | MEDLINE | ID: covidwho-968756

ABSTRACT

BACKGROUND: Efficacy and safety of treatments for hospitalized COVID-19 are uncertain. We systematically reviewed efficacy and safety of remdesivir for the treatment of COVID-19. METHODS: Studies evaluating remdesivir in adults with hospitalized COVID-19 were searched in several engines until August 21, 2020. Primary outcomes included all-cause mortality, clinical improvement or recovery, need for invasive ventilation, and serious adverse events (SAEs). Inverse variance random effects meta-analyses were performed. RESULTS: We included four randomized controlled trials (RCTs) (n = 2296) [two vs. placebo (n = 1299) and two comparing 5-day vs. 10-day regimens (n = 997)], and two case series (n = 88). Studies used intravenous remdesivir 200mg the first day and 100mg for four or nine more days. One RCT (n = 236) was stopped early due to AEs; the other three RCTs reported outcomes between 11 and 15 days. Time to recovery was decreased by 4 days with remdesivir vs. placebo in one RCT (n = 1063), and by 0.8 days with 5-days vs. 10-days of therapy in another RCT (n = 397). Clinical improvement was better for 5-days regimen vs. standard of care in one RCT (n = 600). Remdesivir did not decrease all-cause mortality (RR 0.71, 95%CI 0.39 to 1.28, I2 = 43%) and need for invasive ventilation (RR 0.57, 95%CI 0.23 to 1.42, I2 = 60%) vs. placebo at 14 days but had fewer SAEs; 5-day decreased need for invasive ventilation and SAEs vs. 10-day in one RCT (n = 397). No differences in all-cause mortality or SAEs were seen among 5-day, 10-day and standard of care. There were some concerns of bias to high risk of bias in RCTs. Heterogeneity between studies could be due to different severities of disease, days of therapy before outcome determination, and how ordinal data was analyzed. CONCLUSIONS: There is paucity of adequately powered and fully reported RCTs evaluating effects of remdesivir in hospitalized COVID-19 patients. Until stronger evidence emerges, we cannot conclude that remdesivir is efficacious for treating COVID-19.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , COVID-19/drug therapy , SARS-CoV-2/drug effects , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/therapeutic use , Alanine/administration & dosage , Alanine/adverse effects , Alanine/therapeutic use , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Humans , Randomized Controlled Trials as Topic , Treatment Outcome
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