The American Anti-Vaxxer COVID Dead: A Dynamic Chronicle of Failed Sacrifices

Unlike earlier pandemics, where a "politics of blame" was directed against those who spread infection, the COVID pandemic in the United States has created occasions for the deployment of a "politics of commendation" for performing acts of sacrifice. Frontline healthcare workers have been celebrated for sacrificing themselves in service to their patients, even as critics have charged their being hapless victims of "social murder" at the hands of irresponsible medical administrators. Governmental officials, notably in Texas, have also recommended the elderly to refuse COVID care, die and thus sacrifice themselves selflessly for the benefit of the younger generation. Lately, COVID vaccine-refusal has been seen as an act of noble political sacrifice-typically to further individual liberty against the coercive power of the Federal government's promotion or mandating of vaccination. Anti-vaxxers embracing the role of such political sacrifices, however, generally fail to realize this aspiration, insofar they are often just culpable of their own demise by neglecting public health advisories. Furthermore, the partisan politicization of their deaths militates against the normal recognition of their being sacrifices. Party political calculations have frequently demanded denial of the COVID origins of the anti-vaxxer deaths, and also effectively eliminated any normal attendant rites of reciprocation, memorialization or sacralization of the victims, typical of sacrifices, proper.

Is there an increased incidence of bacteraemia among COVID-19 patients requiring critical care admission who have received IL-6 inhibitors?

Is there an increased incidence of bacteraemia among COVID-19 patients requiring critical care admission who have received IL-6 inhibitors? Introduction: Interleukin-6 (IL-6) inhibitors have been shown to reduce mortality in hospitalised COVID-19 patients. There is, however, concern that induced immunosuppression may increase the risk of secondary nosocomial infection. Objective(s): Our primary aim was to determine if there was increased incidence of bacteraemia in COVID-19 patients requiring critical care admission who had received IL-6 inhibitors compared to those who had not. Method(s): A retrospective review of all COVID-19 admissions to two critical care units in Liverpool from 4th March 2020 to 31st October 2021. Patients were divided into those who received an IL-6 inhibitor (sarilumab or tociluzimab) and those who did not. Hospital antimicrobial policy was to administer a five day prophylactic course of co-amoxiclav and clarithromycin for patients with severe COVID-19 during the study period. Blood culture results from 14 days before admission to critical care and 90 days after admission were included. The blood culture results comprised cultures taken in both critical care and on the wards. Data were linked and analysed using Stata V15.1 (StataCorp, Stata Statistical Software: Release 15, College Station, Texas, USA). Result(s): 894 patients were included in the study. 134 patients had at least one positive blood culture result. The most commonly identified pathogens were Coliforms (23/134, 17.2%), Enterobacter (22/134, 16.4%) and Escherichia coli (16/134, 11.9%). Of patients administered an IL-6 antagonist, 16.8% (114/565) developed a positive blood culture compared to 11.6% (20/172) who did not, p=0.096. We did not observe an increased frequency of antimicrobial resistant culture in the IL-6 administered group 22.8% (26/114) vs. 20.0% (4/20) in this cohort, p=0.781. Data have not been adjusted for demographic and clinical factors in this preliminary analysis. Conclusion(s): We observed a trend toward increased frequency of blood culture positivity in patients administered an IL-6 antagonist within this COVID-19 positive cohort but this was not statistically significant. Further analysis is required to adjust for relevant demographic and clinical factors.

Think Like a Scientist and Engineer: Schools, University, and Community Partnerships Using an Aquaponics Project During COVID-19

One way to expand the time spent teaching science in elementary grades and teacher access to science resources is through partnerships with local universities. This article examines one collaboration that aimed to help students "Think Like a Scientist and an Engineer " using aquaponics. This self-sustainable garden combines aquaculture (fish farming) and hydroponics (growing plants in water). The Biological Sciences Curriculum Study (BSCS) 5E Instructional Model was used to introduce the aquaponics project. This article first discusses the University-School partnership, highlighting the project logistics, successes, challenges, and lessons learned, andfollows up with recommendations for future STEM teaching projects.

SAEM23 Editors‐in‐Chief Welcome

The article offers information on the SAEM 2023 annual meeting, which is considered the first post-COVID gathering, It expresses gratitude for the readers' engagement with the s, which represent the thoughts of over 1300 emergency medicine enthusiasts from various backgrounds and expertise.

Texas grassroots Extension program maintains 50 years of impact in horsemanship

The Texas A&M AgriLife Summer Horsemanship School (SHS) program has been providing horse enthusiasts of all skill levels and ages with horsemanship skills through 2 or 3-d schools for 50 consecutive years. The long-standing impact of the program has been a significant driver for Texas A&M students' experiential learning as horsemanship instructors (~341) and grassroots education across the state for school participants (~29,400). Post surveys for (1) student instructors and (2) school participants were collected and analyzed separately in total for 2018, 2019, 2021, and 2022 to evaluate participant knowledge gained, adoption of new practices, satisfaction, and increased confidence and competence, and student instructor impact. This did not include 2020, due to limited schools taught by former student instructors due to the COVID-19 pandemic. Data was analyzed for descriptive statistics using the means and frequency procedures in SAS 9.4 (Cary, NC). Most school participants were female (77.9%), 15 years old or younger (77.3%), and reported being in 4-H (66.8%). Participants reported having riding experience of less than 1 year (8.2%), 1-5 years (35.3%), 6-10 years (30.4%), or more than 10 years (26.2%). Post-participation survey responses indicate that 81.6% could now do one or more advanced maneuvers that they were previously unable to do (n = 602) and 87.9% reported they were able to ride with more confidence (n = 546). Of the 12 horsemanship topics assessed (Table 1), participants learned "a few or more things" on average 89.1% of the time. When evaluating overall satisfaction, 94.8% stated that they enjoyed most, if not all, of the school. As for the student instructors(n = 21), 88% strongly agreed that their experience in the program had a profound impact on their collegiate careers and believed the skills they developed would be useful in their future careers. The impact of the SHS program is a testimony to the effectiveness of grassroots education on horsemanship in Extension programming, in addition to, collegiate student experiential learning.Copyright © 2023

Spatial Dimensions of Vulnerability: Meatpacking, Socioeconomics, and the Outbreak of COVID-19 in the High Plains of Texas

In May 2020, 2 months after COVID-19 arrived in the High Plains of Texas, meatpacking plant workers were discovered to be contracting the virus in large numbers. Working conditions in the plants-close spacing on the disassembly lines, cold temperatures, noise (shouting to be heard), etc.;along with congregant settings among the immigrant workers before and after work-were all implicated in the infections. Although much has been written on the vulnerabilities of meatpacking workers, little research has investigated the spatial spread of the virus. In this study we analyze COVID-19 case rates for May 15 (the first spike in daily case numbers), for the 41 counties of the region in relation to meat-packing influence, ethnicity, and socioeconomic structure of the counties. We find that meatpacking influence had the strongest relationship to COVID-19 rates across the counties;that the presence of Asian and African immigrants was also significant;and that rurality and isolation insulated more than half the counties from high virus rates. Further analysis, for later spikes in cases (July 1 and November 25), revealed a decline in meatpacking influence, a surge in COVID-19‘s infection of counties with large domestic minorities, and an amplification of low COVID-19 cases for rural, older, Anglo counties. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

One-Year Long-Term Follow up for Post-Acute Sequelae of Covid-19 Pots Patients

Background: Persistence of orthostatic tachycardia, palpitations, and fatigue beyond 4 weeks of an acute COVID-19 infection has been termed Post-Acute Sequelae of COVID-19 (PASC) POTS. We have previously reported 6-month outcomes of PASC POTS. Long-term management and outcomes of these patients is unknown. Objective(s): To examine the long-term management and outcomes of PASC POTS patients. Method(s): We conducted a retrospective study of all patients who were diagnosed with POTS at Cardiology, Neurology, and Rehabilitation Post-COVID clinic after a COVID-19 infection between March 1, 2020, and November 1, 2022, at the University of Texas Health San Antonio. We examined COVID history, POTS diagnosis, management, and one-year outcomes of post-COVID POTS patients. Result(s): In 42 patients that were diagnosed with PASC POTS, 33 had a one-year follow-up. 100% were female, 60.6% were Caucasian. Average age was 40.6 + 11 years while the average BMI was 31.9 + 10.4 kg/m2. The most common symptoms were fatigue (87.9%), palpitations (75.7%), brain fog (72.7%), orthostatic tachycardia, exercise intolerance, and dyspnea (70%). The mean heart rate change with 10-minute standing test was 42.68 + 26.73 beats per minute. At 12-months follow-up, the most common symptom was still fatigue (66.7%), palpitations (45.5%), orthostatic tachycardia, and orthostatic intolerance (42.4%). All patients were managed with increased salt and fluid intake, lower compression stockings and rehabilitation. Fifty five percent of patients were treated with Enhanced External Counter Pulsation (EECP), 42% were treated with beta blockers, 18% with fludrocortisone, 15% with midodrine, and 15% with Pyridostigmine. At 1 year follow-up, 33% of patients reported improvement in their symptoms, 33% reported worsening of symptoms, 24% reported stable symptoms, and 9% had resolution. Conclusion(s): PASC POTS patients continue to experience adverse symptoms even at one year. Physical therapy and rehabilitation and pharmacological therapy appear improve symptoms in a minority of patients.Copyright © 2023

Insurance Status Predicts Endoscopy No-Show

Introduction: Lyndon B. Johnson (LBJ) hospital is a part of the Harris Health System, which provides comprehensive care to the uninsured and underinsured population in Harris County, TX. LBJ serves a population with 55% unemployment and a median household income of $22000. Access to endoscopy is limited by resource availability, and the completion of scheduled endoscopies is essential for public health. We aimed to assess if insurance status was associated with no- show for scheduled endoscopic procedures at the LBJ GI Lab. Method(s): All patients scheduled for outpatient endoscopy during the year 2021 were collected. Included patients must have completed a GI clinic appointment, anesthesia screening, pre-procedural COVID test, confirmed attendance on pre-procedure call, and not showed for scheduled endoscopy (Figure 1). Patient's insurances statuses were: FAP (county payment assistance), Harris County Prisoners (no costs), Medicare/Medicaid (variable costs), Private Insurance (variable costs), Self-Pay, and Texas Family Planning/HCHD Presumed (temporary FAP) (Table 1). Result(s): Comparative analysis of insurance types demonstrated that patients who were Self-Pay were 5.96 times more likely (P< 0.002) not to show up for previously scheduled endoscopic procedures, while patients with the TFP/HCHD insurance were 10.1 times more likely (P< 0.001) to not show when compared to patients who were covered by the county's FAP. Conclusion(s): Our analysis demonstrated a statistically significant association between insurance status and the incidence of no-showing for endoscopy. Upon literature review, there was limited data on rates of endoscopy no-shows in relation to the out-of-pocket commitment for individuals. Further investigation into this topic would significantly affect both the academic and private practice of gastroenterologists. We plan to continue this quality assessment by meeting with the patient eligibility department to assess if modifications of benefit profiles could optimize procedural attendance.

Local Newspaper Coverage of the COVID-19 Pandemic in Two Major Texas Cities: A Visual Comparison of Houston and El Paso

In the US, the absence of a coordinated national response to the COVID-19 pandemic left decision-making to state and local leaders. In Texas, debate over how best to decrease the virus' spread highlighted political tensions between the Republican state leadership and the predominantly Democratic county- and city-leaders. We analyze the daily newspapers of two major cities, Houston and El Paso, to understand similarities and differences in local pandemic-related concerns. We focus specifically on three periods: the days immediately following the first case of COVID-19 in Texas in March 2020, the days surrounding the peak of the first major spike in July 2020, and the days surrounding the second, more deadly spike in January 2021. We trace the progression of the pandemic in Houston and El Paso, analyzing the prevalent newspaper themes and illustrating regional differences through word clouds, which provide a visual analysis of the COVID-19 related coverage. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Improving Access to Extracranial-Intracranial Bypass Surgery in Border Hispanic Communities Utilizing Collaborative Approach Between Plastics and Neurological Surgery

INTRODUCTION: Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas- Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients;COVID-19 further exacerbated this problem with restriction of elective surgical volume. METHOD(S): A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient. RESULT(S): A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes. CONCLUSION(S): We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.

The Impact of Remote Hearing Policies on Racial Equity in Criminal Case Outcomes During the Pandemic

The criminal justice system confronted unprecedented challenges during the COVID-19 pandemic. In response, court systems nationwide quickly instituted policies to enable criminal cases to proceed while protecting public health. The shift toward criminal hearings by videoconference or teleconference has persisted. All fifty states now conduct criminal hearings remotely. Yet evidence about how remote proceedings affect case outcomes remains sparse. Using data for all arrests and criminal case dispositions that occurred in California between 2018 and mid-2021, I characterize the impact the pandemic had on arrest and case resolution rates, estimate the impact of adopting policies to permit remote hearings on conviction and sentencing outcomes, and determine which factors contributed to racial differences in outcomes. Remote hearing policies contributed to racial inequalities in outcomes, which predated the pandemic and persisted amid it.

State Public Health Communications and Public Compliance during the Pre-election SARS-CoV-2 Pandemic: Interpreting the Effectiveness of Messaging Guidelines Utilizing Moral Foundations Theory

Background: State-level public health messaging during the pre-election coronavirus pandemic was very inconsistent. Moral motivational content of the messages, as characterized by moral foundations theory, may have contributed to the degree of compliance in particular states. More attention to this content might result in greater compliance and a lessening of the pandemic's severity. Method(s): A comprehensive review of official state messaging in six U.S. states (California, Florida, Massachusetts, Mississippi, New York, and Texas) was reviewed for the number and distribution of moral foundations as described by moral foundations theory. A search was done for state-level data concerning compliance with mask-wearing and social distancing, the primary public precautionary measures during the pandemic. Rates of compliance by the state were compared with messaging content and analyzed for associations and correlations with the known partisan leanings of the states. Examples of messages with balanced moral foundations, which might be prospectively employed for greater acceptance, were presented. All data were gathered prior to the introduction of the first available vaccine. Result(s): Message review and compliance data suggested that the quantity and proportion of coronavirus-related official messages and the utilization of a balanced combination of moral foundations were associated with higher levels of compliance with the recommended public health measures and lower infection rates. The political orientations of states did not align with the use of known conservative/liberal preferred moral foundations as previously established by Moral Foundations Theory. Conclusion(s): Adjusting messaging with attention to the balanced employment of moral foundations can lead to wider acceptance of and compliance with preventive public health measures.Copyright © 2023 James F. Hall.

WORKER WELL-BEING: Transforming From a Traditional to a More Holistic OSH Program

[...]in 1996, with campus president support, an umbrella safety council was created that includes representation of both OSH and non-OSH activities. Over time, the non-OSH representation has expanded, incorporating representatives from areas such as human resources, building facilities management, employee assistance and wellness, mental health, environmental waste management, campus security and disaster preparedness. With the safety councils support, the wellness and employee assistance programs conducted focus group discussions and determined a major cause of the observed stress was rooted in personal financial management challenges. With the onset of the COVID-19 pandemic in 2020, the safety council members became concerned about the overall well-being of the university community and, as such, assisted in the conduct of two waves of a campus-wide survey measuring aspects such as mental health, well-being concerns about COVID-19, personal finance worries and accessing reliable sources of information.

SARS-CoV-2 VACCINE EFFECTIVENESS IN A COHORT OF ACTIVE-DUTY US MILITARY PERSONNEL

Background: The US Defense Dept launched its COVID-19 vaccination program in Dec 20. The VIRAMP study was designed to address knowledge gaps in US military personnel including vaccine effectiveness against asymptomatic infection, viral carriage and transmission, and durability of protection. Method(s): Military members who had received >=1 dose of an FDA-authorized COVID-19 vaccine were enrolled at 3 sites in Texas May 21-Mar 22 and followed for up to 24 months after first dose. Study activities comprised of three in-person study visits and remote data collection: weekly and monthly questionnaires, self-collection of blood (monthly) and saliva twice weekly (more frequently if symptomatic). Participants shipped self-collected specimens for Ab analyses and SARS-CoV-2 PCR and sequencing. We report an interim analysis on data collected through May 22. Result(s): Participants included 957 military members (60% male, 40% female), with 69% identifying as White, 15% Black/African American, 23% LatinX. Participants were Officers (38%) and Enlisted (62%);54% were healthcare workers. The majority (92.5%) received the Pfizer/BioNTech monovalent A/ Wuhan COVID-19 vaccine;30% of participants received one booster dose. One or more breakthrough infections (bti), defined as positive saliva SARS-CoV-2 PCR, were detected in 228 (24%) participants (36 Delta, 192 Omicron). No differences were detected in rates of symptomatic vs asymptomatic bti by variant or time since last vaccine. Mean age was greater for participants with bti vs those without (35.4 (+/- 7.7) years vs 32 (+/- 8.2) years;p< 0.0001), but no differences were noted by sex, race, or ethnicity. Symptomatic infections (defined as >=2 symptoms) were detected in 43% of participants, whereas 35% of bti were asymptomatic;there were no hospitalizations or deaths. A trend towards reduced duration of saliva positivity was noted in Omicron infections in the 4 months following booster dose compared to infections in the 4 months following primary series (5.3 days vs 12.4 days;p=0.0645). Conclusion(s): Approximately 1/4 of participants had bti in the first year, spanning the evolving epi and vaccination landscape of the pandemic, with about 1/3 demonstrating asymptomatic infection. A trend towards shorter duration of viral carriage following booster dose was noted in Omicron infections. The VIRAMP study demonstrated that prospective surveillance in a large, diverse cohort of US military members utilizing remote specimen and questionnaire collection is operationally feasible.

DISSERTATION NOTICES

The research methodology of the nature, purpose, and participants regarding criteria, ministry context, data collection, and analysis are considered. [...]the significant findings are discussed to ascertain the implication for ministry. The researcher used multiple linear regression analysis to address two research questions that examined whether the five dimensions of courageous followership behavior predict transformational and transactional leadership styles.

Serosurveillance for Severe Acute Respiratory Syndrome Coronavirus 2 Antibody in Feral Swine and White-Tailed Deer in Texas.

Background: Serological evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been reported in white-tailed deer (WTD) in the United States and Canada. Even though WTD are susceptible to SARS-CoV-2 infection, there is no evidence of infection by this virus in other mammalian species that might interact with WTD in nature. Similar to WTD, feral swine are widely distributed and generally occupy the same range as WTD in Texas. The objective of this study was to determine the prevalence of SARS-CoV-2 neutralizing antibody in WTD during 2020 and 2021 and determine the prevalence of SARS-CoV-2 neutralizing antibody in feral swine during 2018 (prepandemic period) and from March 2020 to February 2021 (pandemic period) in Travis County, Texas. Materials and Methods: Sera samples were collected from hunter-killed WTD and feral swine during the prepandemic and pandemic period and tested for SARS-CoV-2 antibody by a plaque reduction neutralization assay in Vero cells. Results: SARS-CoV-2 antibody was not detected in any of the 166 feral swine sera samples, including 24 samples collected during the prepandemic and 142 samples collected during the pandemic period. Furthermore, SARS-CoV-2 antibody was not detected in the 115 WTD samples collected during late 2020, but antibody was detected in WTD in early 2021. Conclusions: The results indicated that SARS-CoV-2 infection of WTD occurred during early 2021 in Travis County, Texas, but serological evidence of SARS-CoV-2 infection was not detected in the feral swine samples collected from the same locality and during the same time period of the collection of WTD samples.

How Life During a Pandemic May Have Contributed to Homicide in Houston, Texas

This study offers an examination of a sample of 150 homicides in Houston, Texas in 2020 as described by local news sources. The purpose was to understand dynamics that may explain what appears to be an increase in domestic disputes that led to increases in homicides. This mixed method study utilized content analysis that included quantifying the patterns of concepts in the news reports to isolate racial, gender and location factors. Data are displayed in tables and figures to illustrate patterns and regression analyses indicate predictive relations. The study is important given the recent homicide increases during the COVID-19 pandemic, and the substantial impact on families and communities. The data reveal that domestic disputes and access to firearms are evident in the increases. The study offers implications for micro and macro responses involving media coverage, interpersonal communication, community programming and messaging, law enforcement engagement, and justice system reforms.Key Take Away Points [list] [list] [list_item] increase in homicide during COVID-19 [/list_item] [list_item] decrease in police presence [/list_item] [list_item] majority of homicides are caused by guns [/list_item] [/list]

Mortality And Morbidity Burden Of Covid-19 Infection In Left Ventricular Assist Device Patients

Introduction: COVID-19 pandemic has resulted in more than 6.1 million deaths and more than 480 million infections worldwide (1). Left ventricular assist device patients (LVAD) with their multiple co-morbidities are at high risk for morbidity and mortality from the COVID-19 infection. Few studies and case reports demonstrating the outcomes of COVID-19 infection in LVAD patients have been published, with the most recent study in 2021 (2-4). However, none of these studies spanned the entire stretch of the pandemic. Hypothesis: : COVID-19 infection would result in significant mortality and multi-system complications among patients with an LVAD. Method(s): IRB approval was obtained for our retrospective cohort study. 225 LVAD patients across two large centers in Texas, USA were screened for COVID-19 infection from December 1, 2019 to February 28, 2022. 68 events of COVID-19 infection were identified among 64 patients. One patient was excluded due to false positive test and 3 patients were infected twice and counted as separate events. Outcomes including mortality, respiratory failure, bleeding, and thromboembolic complications were assessed. Result(s): Baseline characteristics and results are summarized in Table 1. 51% of the patients needed hospitalization or emergency department visit for COVID infection. Five patients were intubated (7.4%). 6 patients developed chronic hypoxic respiratory failure requiring outpatient supplemental oxygen. 4 patients suffered from ventricular tachycardias while three other patients had Implantable cardioverter Defibrillator (ICD) shocks during COVID infection. 9 patients had epistaxis or gastrointestinal bleeding within 1 month of testing COVID positive. One HM2 patient had confirmed LVAD outflow cannula thrombus on CT heart and another patient with HeartWare had confirmed inflow cannula thrombus requiring emergent exchange to HM3 due to pump stoppage. Three patients suffered a stroke (5%). No events of pulmonary emboli or DVTs were noted. The mortality rate among this cohort was 14% (9 out of 64 patients). Four patients died during the same hospitalization. 33% had HM2 and 67% had HM3 LVADs, making a mortality rate of 37% (3 out of 8) for HM2 patients and 9% for HM3 (6 out of 55). 88% were males, 56% were African Americans, 67% had NICM, and 78% had at least moderate RV dysfunction at baseline. Conclusion(s): COVID-19 infection resulted in significant mortality and complications including stroke, pump thrombus, arrhythmias, respiratory failure, and bleeding events among LVAD patients.Copyright © 2022

A case of anaphylaxis to the BNT162b2 mRNA COVID-19 vaccine in a patient with confirmed polyethylene glycol allergy

Case report The Food and Drug Administration (FDA) provided emergency use authorization (EUA) for the Pfizer/BioNTech (BNT162b2) COVID-19 vaccine in December 2020. Implementation of COVID-19 mass vaccination efforts were implemented soon after. However, following the FDAs EUA, COVID-19 vaccine allergic reactions were reported. These findings led to concerns about vaccine hesitancy and the possible avoidance of future doses. The Texas Children's Hospital COVID-19 Vaccine Hypersensitivity Clinic was established in December 2020 to help address these concerns and to evaluate both pediatric and adult patients with immediate allergic reactions to the COVID-19 vaccines, as well as evaluating patients with polyethylene glycol (PEG) or polysorbate (PS) allergy. We present the case of an 18yo female who experienced anaphylaxis following her second Pfizer mRNA COVID-19 vaccine. The patient developed symptoms of generalized hives, chest tightness and dyspnea 17 minutes after receiving the Pfizer mRNA COVID-19 vaccine. She was treated in the emergency department with IM prednisone and PO diphenhydramine. Of note, in 2018, she had a similar response to her HPV9 vaccine (containing PS 80). Tryptase wasn't obtained at the time of her COVID-19 or HPV9 vaccine reactions, but she did have a baseline that was normal around 4ng/mL. Skin testing was performed to the following: PEG 3350, PS 20 and PS 80. Skin testing (skin prick and intradermal) were negative for PS20 and PS80. PEG 3350 skin prick was negative but methylprednisone acetate (PEG 3350) was positive at the 4mg/mL intradermal testing strength. She underwent a Miralax (PEG 3350) oral challenge. Within 20 minutes of ingesting 0.17grams PEG 3350 she developed an itchy macular rash on neck and upper chest, nausea and a globus throat sensation. She was treated with PO cetirizine and symptoms improved. Tryptase level was obtained 30 min after the start of her reaction and was 4ng/mL. Given the patient's reaction, she was advised to avoid PEG containing products and will return to undergo a graded-step challenge to the Janssen (J&J) COVID-19 vaccine. The prevalence of COVID-19 mRNA vaccine anaphylaxis and PEG allergies is rare. However, allergy referral is warranted in cases of immediate reactions to the COVID-19 vaccine or history of PEG or polysorbate allergies.

Could COVID-19 Become a Policy Tipping Point? A Q&A With Kavita K. Patel, MD, MS

Am J Manag Care. 2020;26(10):421-422. https://doi.org/10.37765/ajmc.2020.88499 _____ AJMC®: Something that has been noted throughout this 25th anniversary interview series is that Americans probably don't have the will or the capacity to do anything different in terms of lowering the cost of care or widening access to care and that institutions are slow to adopt change. In discussing the health care system, we saw that providers that were only in fee-for-service arrangements really got slammed. If a state was kind of on the bubble and didn't want to do work requirements and felt like they were getting, quote, pressure from the Trump administration, maybe that could be undone. [...]yes, I would expect a Biden administration to not just [undo] work requirements, but to put out a series of those same kinds of guidances and notifications that actually encourage expansion of Medicaid and to do some of the things that I think the Obama administration started, where they did quality measure harmonization, accountable care organizations.