Challenges in Communication about COVID Medical Risks: A Speculative Educational Template

Recent descriptions of the pandemic's effect in medical offices and hospitals depict unprecedented scenarios. The impact of COVID-19 on individuals sick enough to seek professional healthcare highlights the importance of communication skills. We propose an educational framework for pre-service and in-service healthcare professionals to improve communication skills during this crisis. Clinicians need to be mindful that the perception of the seriousness of the consequences of treatment vary greatly between individual patients and families. The four-quadrant scheme we offer is a way to help providers prepare to speak effectively about medical choices related to COVID. While most situations demand more than one type of communication competency, the focus here is on what might be advisable as the primary or "lead” skill. One of the most important elements in managing COVID-19 is to empower patients with appropriate information and emotional support. Additionally, we hope this model will inspire health professions faculty to think in new ways about teaching and coaching options in the practice-based learning of communication skills. © 2023 Helen Meldrum & Mary Hardy.

Brain fog in long COVID limits function and health status, independently of hospital severity and preexisting conditions.

Importance: The U.S. government has named post-acute sequelae of COVID-19 (longCOVID) as influential on disability rates. We previously showed that COVID-19 carries a medical/functional burden at 1 year, and that age and other risk factors of severe COVID-19 were not associated with increased longCOVID risk. Long-term longCOVID brain fog (BF) prevalence, risk factors and associated medical/functional factors are poorly understood, especially after mild SARS-CoV-2 infection. Methods: A retrospective observational cohort study was conducted at an urban tertiary-care hospital. Of 1,032 acute COVID-19 survivors from March 3-May 15, 2020, 633 were called, 530 responded (59.2 ± 16.3 years, 44.5% female, 51.5% non-White) about BF prevalence, other longCOVID, post-acute ED/hospital utilization, perceived health/social network, effort tolerance, disability. Results: At approximately 1-year, 31.9% (n = 169) experienced BF. Acute COVID-19 severity, age, and premorbid cardiopulmonary comorbidities did not differ between those with/without BF at 1 year. Patients with respiratory longCOVID had 54% higher risk of BF than those without respiratory longCOVID. BF associated with sleep disturbance (63% with BF vs.29% without BF, p < 0.0001), shortness of breath (46% vs.18%, p < 0.0001), weakness (49% vs.22%, p < 0.0001), dysosmia/dysgeusia (12% vs.5%, p < 0.004), activity limitations (p < 0.001), disability/leave (11% vs.3%, p < 0.0001), worsened perceived health since acute COVID-19 (66% vs.30%, p < 0.001) and social isolation (40% vs.29%, p < 0.02), despite no differences in premorbid comorbidities and age. Conclusions and relevance: A year after COVID-19 infection, BF persists in a third of patients. COVID-19 severity is not a predictive risk factor. BF associates with other longCOVID and independently associates with persistent debility.

Post-lockdown spatiotemporal pattern of COVID clustering in North 24 Parganas, West Bengal, India

Many scholars and researchers have studied the CoVID-19 epidemic's spread using GIS technologies since it first appeared. The CoVID-19 pandemic is thought to be rife with unknowns, and many of them have a spatial component that makes the phenomenon understood as being spatially and possibly mappable. The majority of these efforts, though, have been made at the national, state, or district, levels. Very few studies primarily concentrate on the display of the CoVID-19 cluster at a local or neighborhood scale. From the perspective of micro-planning, analyzing the clustering, geographical direction, and heterogeneity of the CoVID-19 hotspots' spatial pattern is crucial specially when mass has returned to new normal living style. Using a case study on the North 24 Parganas of West Bengal, India, the most vulnerable district in West Bengal, we attempt to analyze the CoVID-19 diffusion at the block level in post-lockdown period. We assess the spatiotemporal distribution of CoVID-19 and map its hotspots based on the containment zones. This study demonstrates the patterns of geographical dispersion and the CoVID-19 pandemic spread in North 24 Parganas which is highly concentrated along the western boundaries of the state. We observed that the containment clusters of 2020 once more noted a higher density of CoVID cases in 2022 and validates the findings of the current study. It promises to corroborate the study into the geographic relation and spread of CoVID-19. By examining such spatial distribution patterns, the government might be able to track and predict the transmission of the infection in neighborhoods of blocks. © 2022, The Author(s), under exclusive licence to Korean Spatial Information Society.

Factors affecting climacteric women with SARS-CoV-2 infection: A multinational Latin America study (REDLINC XI).

OBJECTIVE: To evaluate the association between factors, especially those linked to the climacteric, and a history of COVID-19 infection. METHODS: This was an observational, cross-sectional, and analytical study in which women from ten Latin American countries, aged 40-64, who attended a routine health check-up were invited to participate. A positive history for COVID-19 was based on reverse transcription-polymerase chain reaction reports. We evaluated sociodemographic, clinical, lifestyle, anthropometric variables, and menopausal symptoms using the Menopause Rating Scale (MRS). RESULTS: A total of 1238 women were included for analysis, of whom 304 (24.6 %) had a positive history for COVID-19. The median [interquartile range: IQR] age of participants was 53 [IQR 12] years, duration of formal education was 16 [6] years, body mass index 25.6 [5.1] kg/m2, and total MRS score 10 [13]. In a logistic regression model, factors positively associated with COVID-19 included postmenopausal status and having a family history of dementia (OR: 1.53; 95 % CI: 1.13-2.07, and 2.40; 1.65-3.48, respectively), whereas negatively associated were use of menopausal hormone therapy (current or past), being a housewife, and being nulliparous (OR: 0.47; 95 % CI: 0.30-0.73; 0.72; 0.53-0.97 and 0.56; 0.34-0.92, respectively). Smoking, being sexually active, and use of hypnotics were also factors positively associated with COVID-19. CONCLUSION: Postmenopausal status and a family history of dementia were more frequent among women who had had COVID-19, and the infection was less frequent among current or past menopause hormone therapy users and in those with less physical contact.

Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa.

BACKGROUND: Little is known about the clinical care, use of medicines, and risk factors associated with mortality among the population with private health insurance with COVID-19 in South Africa. METHODS: This was a retrospective cross-sectional study using claims data of patients with confirmed COVID-19. Sociodemographics, comorbidities, severity, concurrent/progressive comorbidity, drug treatment, and outcomes were extracted from administrative data. Univariate and multivariate logistic regression models were used to explore the risk factors associated with in-hospital death. RESULTS: This study included 154,519 patients with COVID-19; only 24% were categorized as severe because they received in-hospital care. Antibiotic (42.8%) and steroid (30%) use was high in this population. After adjusting for known comorbidities, concurrent/progressive diagnosis of the following conditions were associated with higher in-hospital death odds: acute respiratory distress syndrome (aOR = 1.55; 95% CI = 1.44-1.68), septic shock (aOR = 1.55; 95% CI = 2.00-4.12), pneumonia (aOR = 1.35; 95% CI = 1.24-1.47), acute renal failure (aOR = 2.30; 95% CI = 2.09-2.5), and stroke (aOR = 2.09; 95% CI = 1.75-2.49). The use of antivirals (aOR = 0.47; 95% CI= 0.40-0.54), and/or steroids (aOR = 0.46; 95% CI = 0.43-0.50) were associated with decreased death odds. The use of antibiotics in-hospital was not associated with increased survival (aOR = 0.97; 95% CI = 0.91-1.04). CONCLUSIONS: Comorbidities remain significant risk factors for death mediated by organ failure. The use of antibiotics did not change the odds of death, suggesting inappropriate use.

Social Media, Public Health, and Community Mitigation of COVID-19: Challenges, Risks, and Benefits.

Shortly after the first case reports in 2019, COVID-19 was declared a pandemic. Early messages from trusted experts, which later proved to be inadequate or incorrect, highlight the need for continual adjustment of messages to the public as scientific knowledge evolves. During this time, social media exploded with greatly sought-after information, some of which was misinformation based on incomplete or incorrect facts or disinformation purposefully spread to advance a specific agenda. Because of the nature of social media, information, whether accurate or not at the time posted, lives on and remains accessible to the public even when its usefulness has been discredited. While the impact of mis/disinformation on COVID-19 risk-reducing behaviors is debatable, it is clear that social media has played a significant role in both extending the reach of COVID-19-related falsehoods and promoting evidence-based content. Over the last decade, social media has become a dominant source of information that consumers turn to for health information. A great deal of misinformation and disinformation has reached large numbers of social media users, which points to a need for the agencies of the US Public Health Service to create communications to convey accurate and current information and appeals that will actually be viewed. This viewpoint highlights the challenges, risks, and potential benefits that social media present in mitigating the COVID-19 pandemic.

Association of COVID-19 mortality with politics and on-demand testing in 217 U.S. counties.

BACKGROUND: Previous research found increased COVID-19 spread associated with politics and on-demand testing but not in the same study. The objective of this study is to estimate the contribution of each corrected for the other and a variety of known risk factors. METHODS: Using data from 217 U.S. counties of more than 50,000 population where testing data were available in April, 2021, the associations of COVID-19 deaths with politics, testing and other risk factors were examined by Poisson and least squares regression. RESULTS: Statistical controls for 15 risk factors failed to eliminate the association of COVID mortality risk with percent of vote for Donald Trump in 2016 or negative tests per population. Each is independently predictive of increased mortality. CONCLUSION: Apparently, many people who test negative for the SARS-CoV-2 virus engage in activities that increase their risk, a problem likely to increase with the availability of home tests. There is no association of negative tests with the Trump vote but, according to polling data, Trump voters' past resistance to public health recommendations has been extended to resistance to being vaccinated, threatening the goal of herd immunity.

Evaluation of measures to prevent the spread of COVID-19 on the construction sites.

COVID-19 is the most critical health and safety risk facing the global construction sector. The COVID-19 crisis leads to a reduction in site productivity, has increased compliance costs, delayed projects and increased construction workers' exposure to risk and infections. However, as countries begin to ease lockdowns and restrictions, there is a need to examine the measures that the construction companies can take to ensure workers are "Covid-safe". This research developed a questionnaire instrument that included 24 Covid-preventive measures on construction sites. Isolating sick workers, conducting daily checks for COVID-19 symptoms, preventing hugging/handshaking at the site, displaying health advisory posters and info-graphics, and providing face masks to workers are seen to be the main measures towards keeping sites "Covid-safe". The Principal Component Analysis structured the 24 measures into 4 components. The 4 components explained about 73% of the model, namely hygiene and control, equipment and monitoring, awareness, and incentives. The results found that compliance costs of health and safety regulations to prevent COVID-19 will increase project cost by more than 20%, site productivity will be reduced by up to 50%, and the pandemic will have caused a 40% increase in skill shortages. Cluster analysis was performed to cluster the sites in terms of their exposure to COVID-19 risk. In order to examine the practicability of the findings, the model was validated with 4 case studies. It is asserted that the research findings have the potential to keep sites "Covid-safe", which helps construction companies increase productivity, reduce project costs, reduce claims, and deliver projects on schedule. This research is the first to examine measures to prevent the spread of COVID-19 on construction sites, and the findings hold critical theoretical and practical implications for future research on health and safety management.

An analysis of mortality and survival of COVID 19 patients admitted to a tertiary care hospital in Maharashtra, India.

BACKGROUND: After nine months of responding to the coronavirus disease-19 (COVID-19) pandemic, the scientific fraternity is yet to unravel the mystery of those who are at most risk from mortality. Despite resistance to wear masks, the global public health response has beaten the grimmer projections of millions of deaths. The present study seeks to analyze the survival of COVID-19 patients at a tertiary care hospital and identify the risk factors of mortality. METHODS: Medical records of 1233 RT PCR confirmed COVID-19 patients admitted in a tertiary care hospital between 01 April and 30 September 2020 were retrospectively analyzed for calculating overall survival and to investigate the independent predictors of survival of COVID-19 patients. RESULTS: There were 72 (5.8%) deaths; which occurred in 24.9% of the elderly (age > 60yrs) people (P < 0.001), 76.0% in people with multiple comorbidities (having more than one comorbidity) (P < 0.001), 75.6% in people with diabetes (P < 0.001), and 75.5% in people with hypertension (P < 0.001). A significantly higher risk of mortality was observed in elderly patients, patients with comorbidities, and patients requiring oxygen while admitted in the hospital. CONCLUSION: Survival reflects the cure rates and is used by health professionals and policymakers to plan and implement disease control measures. The insights provided by the study would help facilitate the identification of patients at risk and timely provision of specialized care for the prevention of adverse outcomes in the hospital setting.

Hospitality workers' COVID-19 risk perception and depression: A contingent model based on transactional theory of stress model.

The hospitality industry worldwide is suffering under the COVID-19 pandemic. Drawing on the transactional theory of stress and coping, this study aims to investigate when hospitality workers' COVID-19 risk perception affects their likelihood of having depressive symptoms. Using data from 211 hospitality workers in 76 hotels in Peru, we examined the effects of perceived COVID-19 risk on the likelihood of experiencing depressive symptoms. We posited that this relationship is moderated by the workers' environment at work (job satisfaction) and at home (the number of children). The results indicate that job satisfaction weakens the link between hospitality workers' COVID-19 risk perception and their likelihood of depressive symptoms while the number of children exacerbates this link. We discuss the implications of our findings for research on COVID-19 risk perception and offer practical implications for hospitality workers under COVID-19 crisis.

Triaging Interventional Pain Procedures During COVID-19 or Related Elective Surgery Restrictions: Evidence-Informed Guidance from the American Society of Interventional Pain Physicians (ASIPP).

BACKGROUND: The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of "elective" interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures.Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. OBJECTIVES: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. METHODS: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. RESULTS: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included urgent, emergency, and elective procedures. Examples of urgent and emergency procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, emergency procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. LIMITATIONS: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. CONCLUSION: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus.

Evidence-Based Risk Mitigation and Stratification During COVID-19 for Return to Interventional Pain Practice: American Society of Interventional Pain Physicians (ASIPP) Guidelines.

BACKGROUND: Chronic pain patients require continuity of care even during the COVID-19 pandemic, which has drastically changed healthcare and other societal practices. The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-ASIPP Risk Mitigation & Stratification (COVID-ARMS) Return to Practice Task Force in order to provide guidance for safe and strategic reopening. OBJECTIVES: The aims are to provide education and guidance for interventional pain specialists and their patients during the COVID-19 pandemic that minimizes COVID-related morbidity while allowing a return to interventional pain care. METHODS: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various regions, specialities, and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification were reviewed. The principles of best evidence synthesis of available literature and grading for recommendations as described by the Agency for Healthcare Research and Quality (AHRQ) typically utilized in ASIPP guideline preparation was not utilized in these guidelines due to limitations because of their lack of available literature on COVID-19, risk mitigation and stratification. These guidelines are considered evidence -- informed with incorporation of best available research and practice knowledge. Consequently, these guidelines are considered evidence-informed with incorporation of best available research and practice knowledge. RESULTS: Numerous risk factors have emerged that predispose patients to contracting COVID-19 and/or having a more severe course of the infection. COVID-19 may have mild symptoms, even be asymptomatic, or may be severe and life threatening. Older age and certain comorbidities, such as underlying pulmonary or cardiovascular disease, have been associated with worse outcomes. In pain care, COVID-19 patients are a heterogeneous group with some individuals relatively healthy and having only a short course of manageable symptoms while others become critically ill. It is necessary to assess patients on a case-by-case basis and craft individualized care recommendations. A COVID-ARMS risk stratification tool was created to quickly and objectively assess patients. Interventional pain specialists and their patients may derive important benefits from evidence-informed risk stratification, protective strategies to prevent infection, and the gradual resumption of treatments and procedures to manage pain. LIMITATIONS: COVID-19 was an ongoing pandemic at the time during which these recommendations were developed. The pandemic has created a fluid situation in terms of evidence-informed guidance. As more and better evidence is gathered, these recommendations may be modified. CONCLUSIONS: Chronic pain patients require continuity of care but during the time of the COVID-19 pandemic, steps must be taken to stratify risks and protect patients from possible infection to safeguard them from COVID-19-related illness and transmitting the disease to others. Pain specialists should optimize telemedicine encounters with their pain patients, be cognizant of risks of COVID-19 morbidity, and take steps to evaluate risk-benefit on a case-by-case basis. Pain specialists may return to practice with lower-risk patients and appropriate safeguards.

Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis.

The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient (r), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI: 17.1-30.9%), and mortality was 13% (9.3-18%). The age-adjusted meta-regression models showed significant association of mortality with male (r: 0.14; OR: 1.15; 95% CI: 1.07-1.23; I 2: 95.2%), comorbidities including pre-existing cerebrovascular disease (r: 0.35; 1.42 (1.14-1.77); I 2: 96.1%), and chronic liver disease (r: 0.08; 1.08 (1.01-1.17); I 2: 96.23%), complications like septic shock (r: 0.099; 1.10 (1.02-1.2); I 2: 78.12%) and ARDS (r: 0.04; 1.04 (1.02-1.06); I 2: 90.3%), ICU admissions (r: 0.03; 1.03 (1.03-1.05); I 2: 95.21%), and IMV utilization (r: 0.05; 1.05 (1.03-1.07); I 2: 89.80%). Similarly, male (r: 0.08; 1.08 (1.02-1.15); I 2: 95%), comorbidities like pre-existing cerebrovascular disease (r: 0.29; 1.34 (1.09-1.63); I 2:93.4%), and cardiovascular disease (r: 0.28; 1.32 (1.1-1.58); I 2: 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most.