Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War.

OBJECTIVE: The aim of this study was to evaluate the change in knowledge and skill confidence after implementation of a chemical, biological, radiological, nuclear, and explosive (CBRNE) training course during the Russia-Ukraine War. METHODS: Pre/post-test study in the Ukrainian cities of Kyiv, Dnipro, Zaporizhzhia, and Odesa. Fifteen CBRNE courses were conducted over a 3-mo period, August to October 2022. Change in knowledge and skills confidence were evaluated with pre/post-course written exams and practical skill assessments that were observed during the training exercises. Changes were analyzed based on nonparametric Wilcoxon matched-pairs signed-rank testing. Pre/post self-efficacy surveys were analyzed with McNemar's test for paired data. Course evaluations were conducted with standardized questions which assessed instruction quality, teaching relevance, knowledge gained, and post-course skills confidence. RESULTS: A total of 523 participants registered and completed 1 of the 15 courses. Overall mean pre-course test score: 57.8% (SD 20.7%); mean post-course test score: 81.4% (SD 11.3%); participants with increasing test scores: 90.7%; mean difference in score (95% confidence interval) 23.6% (21.2%-25.9%), P < 0.0001. Pre/post self-efficacy surveys (4-point Likert scale) noted participants recognized signs and symptoms of a CBRNE incident, and necessary skills to manage CBRNE exposures, P < 0.0001. CONCLUSIONS: The implementation of this CBRNE course for front-line providers in Ukraine was successful. To our knowledge, it was the first implementation of a field course during the current Russian-Ukraine war. Future research should evaluate knowledge retention and impact of our innovative Train-the-Trainer model. Further iterations should emphasize expanding the quantity of training equipment and practical skill sessions.

Infection with SARS-CoV-2 variant Gamma (P.1) in Chile increased ICU admission risk three to five-fold.

The 2021 wave of SARS-CoV-2 infection in Chile was characterized by an explosive increase in ICU admissions, which disproportionately affected individuals younger than 60 years. This second wave was also accompanied by an explosive increase in Gamma (P.1) variant detections and the massive vaccine rollout. We unveil the role the Gamma variant played in stressing the use of critical care, by developing and calibrating a queueing model that uses data on new onset cases and actual ICU occupancy, symptom's onset to ICU admission interval, ICU length-of-stay, genomic surveillance, and vaccine effectiveness. Our model shows that infection with the Gamma (P.1) variant led to a 3.5-4.7-fold increase in ICU admission for people younger than 60 years. This situation occurred on top of the already reported higher infection rate of the Gamma variant. Importantly, our results also strongly suggest that the vaccines used in Chile (inactivated mostly, but also an mRNA), were able to curb Gamma variant ICU admission over infections.

Explosive COVID-19 outbreak in a German nursing home and the possible role of the air ventilation system.

BACKGROUND: Most COVID-19 outbreaks in nursing homes are explained by transmission of SARS-CoV-2 from nurses or visitors. METHODS AND RESULTS: We describe an outbreak with 64 of the 67 residents identified as COVID-19 cases within two weeks (34 in nursing block 1, 30 in nursing block 2), at least 32 of them had relevant symptoms of COVID-19. Thirteen of the residents' deaths were associated with COVID-19. In addition, 27 of approximately 60 staff members were identified as COVID-19 cases, 23 of them had relevant symptoms. In none of the samples from residents or staff was a mutation of SARS-CoV-2 detected. Quarantine of the residents was already in force at the beginning of the outbreak. A common source among the staff was considered to be unlikely because the two nursing home blocks had no staff rotation and the staff had to wear FFP2 masks during contact with residents. Three months after the outbreak the RNA of SARS-CoV-2 was detected on 14 of 39 sampled indoor surfaces of the air ventilation system with Ct values between 34.9 and 41.9, but only at the air supply in the corridor (11 of 24 samples) and the air overflow in the door between the corridor and the residents' rooms (three of 11 samples) but not at the air exhaust in the residents' bathrooms. CONCLUSIONS: The air ventilation system and an inversion weather situation three days before the first confirmed case may have enhanced viral spread inside the nursing home assuming that a common source with a high viral load had existed at the time of outbreak.

Emergence of two distinct variants of SARS-CoV-2 and an explosive second wave of COVID-19: the experience of a tertiary care hospital in Pune, India.

The emergence of novel variants of SARS-CoV-2 in several countries has been associated with increased transmissibility or reduced neutralization potential of antibodies against the Wuhan virus (wild type). From August 2021 onwards, India experienced a progressive decline in the number of active SARS-CoV-2 infections, indicative of a downward trend in the explosive second wave. This prospective study was conducted quarterly for one year (May 2020 to June 2021) at a tertiary care hospital in the city of Pune in western India. Receptor-binding domain (RBD, n = 319) and full genome (n = 20) sequences from viral-RNA-positive nasopharyngeal swabs of COVID-19 patients representing the first and second waves were used for analysis. No Brazilian, South African, or California variants were detected in this study. Until December 2020, only the wild-type strain was prevalent. Concurrent with the upsurge of the second wave in March 2021, 73% (33/45) of RBD sequences harboured L452R/E484Q mutations characteristic of the Kappa variant. In April 2021, co-circulation of Kappa (37%) and Delta (L452R/T478K, 59%) variants was recorded. During May and June 2021, the Delta variant became the predominant circulating variant, and this coincided with a significant decline in the number of COVID-19 cases. Of the 20 full genome sequences, six isolates each exhibited signature mutations of the Kappa and Delta variant. With several states witnessing a reduction in the number of COVID-19 cases, continuous monitoring of newer mutations and assessment of their effect on virus transmissibility and their impact on vaccinated or previously exposed individuals is necessary.

Lower-Limb Muscle Contractile Properties, Explosive Power and the Subjective Response of Elite Soccer Players to the COVID-19 Lockdown.

The present study examined the effects of the lockdown period on basic anthropometric measures, countermovement jumping performance, skeletal muscle contractile properties derived from tensiomyography (TMG), injury incidence, and self-assessed general well-being in elite soccer players. A total of 266 players were assessed before (PRE) and 32 players were reassessed 11 days after (POST) the COVID-19 period. Significant changes in the TMG parameters were observed POST compared to PRE: contraction time (Tc) increased from 6% to 50% in vastus lateralis [VL] (p = 0.009) and biceps femoris [BF] (p < 0.001), respectively; whereas radial displacement (Dm) increased for 19% in BF (p = 0.036) and 17% in VL (p < 0.001), respectively. Jumping performance remained unchanged from PRE to POST In addition, athletes rated the lockdown period as a positive event and felt psychologically better during the lockdown, primarily because they spent more time with family members and friends. Although there were no differences in any of the variables describing lower limb muscle power following the two-month lockdown, the altered contractile properties of the assessed muscles suggest suboptimal conditioning of the football players.

The Impact of COVID-19 Lockdown on Agility, Explosive Power, and Speed-Endurance Capacity in Youth Soccer Players.

Our goal was to assess agility, explosive power, and speed-endurance capacity by implementing noninvasive procedures and sport-specific tests. We hypothesized that agility, speed, explosive power, and speed-endurance capacity might be maintained or increased by an individualized home-based training program. Eleven adolescent athletes participated in our study; they executed three tests before the coronavirus outbreak and 13 weeks later, after the pandemic curfew. We used the SpeedCourt System to assess the sport-specific speed and agility parameters and monitor speed-endurance capacity. We conducted the first measurement at the end of the preparatory period, on 28 February 2020. The second session consisted of 4 weeks of regular training and 9 weeks of individual, home-based activities. Compared to the first (pre-pandemic) testing session, our participants demonstrated a significantly improved capacity of the lower limbs' explosive strength after completing the home-based exercise routine, compared to the first (pre-pandemic) testing session. We found that agility, speed, and explosive power might be maintained at the same level under home-based conditions. We found that it was challenging for the participants to increase their "pre-pandemic" endurance capacities.

Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction.

BACKGROUND: Nosocomial outbreaks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are frequent despite implementation of conventional infection control measures. An outbreak investigation was undertaken using advanced genomic and statistical techniques to reconstruct likely transmission chains and assess the role of healthcare workers (HCWs) in SARS-CoV-2 transmission. METHODS: A nosocomial SARS-CoV-2 outbreak in a university-affiliated rehabilitation clinic was investigated, involving patients and HCWs, with high coverage of pathogen whole-genome sequences (WGS). The time-varying reproduction number from epidemiological data (Rt) was estimated, and maximum likelihood phylogeny was used to assess genetic diversity of the pathogen. Genomic and epidemiological data were combined into a Bayesian framework to model the directionality of transmission, and a case-control study was performed to investigate risk factors for nosocomial SARS-CoV-2 acquisition in patients. FINDINGS: The outbreak lasted from 14th March to 12th April 2020, and involved 37 patients (31 with WGS) and 39 employees (31 with WGS), 37 of whom were HCWs. Peak Rt was estimated to be between 2.2 and 3.6. The phylogenetic tree showed very limited genetic diversity, with 60 of 62 (96.7%) isolates forming one large cluster of identical genomes. Despite the resulting uncertainty in reconstructed transmission events, the analyses suggest that HCWs (one of whom was the index case) played an essential role in cross-transmission, with a significantly greater fraction of infections (P<2.2e-16) attributable to HCWs (70.7%) than expected given the number of HCW cases (46.7%). The excess of transmission from HCWs was higher when considering infection of patients [79.0%; 95% confidence interval (CI) 78.5-79.5%] and frail patients (Clinical Frailty Scale score >5; 82.3%; 95% CI 81.8-83.4%). Furthermore, frail patients were found to be at greater risk for nosocomial COVID-19 than other patients (adjusted odds ratio 6.94, 95% CI 2.13-22.57). INTERPRETATION: This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, this study shows that despite such uncertainty, significant transmission patterns can be observed.

Stress and Physical Inactivity: Two Explosive Ingredients for the Heart in COVID-19 Pandemic Times.

BACKGROUND: Coronavirus disease 2019 (Covid-19) pandemic is a global health crisis that has culminated in thousands of deaths. In order to reduce the spread of the Sars-CoV-2 virus, governments of several countries have adopted social isolation as a strategy. However, social isolation has culminated in deleterious effects on the population's health, including increased physical inactivity, stress and, consequently, adverse changes in body composition, cardiorespiratory capacity, muscle strength, physical functionality, and vascular events, which are increasingly pointed out as the main determinants of cardiovascular health. Staying physically active during lockdown is a challenge, especially for the population with a higher risk of mortality from COVID-19, who are still encouraged to maintain social distance until there is a vaccine available. Strategies to avoid physical inactivity and reduce stress levels can promote cardiovascular protection and must be considered during COVID-19 time. OBJECTIVE: The aim of this paper is to discuss the risks of physical inactivity and stress for the cardiovascular system during the COVID-19 pandemic and propose strategies to protect cardiovascular health. CONCLUSION: A home-based training protocol could be an interesting and effective strategy for the population who need to remain physically active and safe at home.

From health emergency preparedness to response action: a long journey in Lebanon.

Emergency preparedness is a critical pillar of the International Health Regulations (IHR), a legally binding instrument underlying the global health security regime that came into effect in 2005. Lebanon, a small country of 10 452 km2 bordering the eastern Mediterranean, ratified the IHR in 2007 after the devasting effects of a sudden military conflict in 2006 that severely impacted the recovering health system. Moreover, the Lebanese health system infrastructure was only just recovering from 15 years of civil war that ended in 1990. Since 2005, the country has also faced a complex refugee crisis potentiating the risk of disease outbreaks since 2011, in addition to a severe financial crisis that has degenerated into social unrest since October 2019, and more recently the COVID-19 pandemic since February 2020.