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1.
J Nurs Adm ; 52(12): 672-678, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2327706

ABSTRACT

In New Jersey, a statewide nurse residency program was implemented using an apprenticeship model. The pandemic created disruption to registered nurse residency programs. This included rapid restructuring of program delivery to online methods and a need to adapt curricula to reflect changing practice and guidelines. As a result of the pandemic, new graduates had educational gaps and nurse leaders experienced staffing shortages. First year program outcomes demonstrated a 90% retention of new graduates and financial benefits for organizations participating in the statewide nurse residency program.


Subject(s)
Internship and Residency , Humans , Program Evaluation , Curriculum , New Jersey
3.
BMC Public Health ; 23(1): 423, 2023 03 03.
Article in English | MEDLINE | ID: covidwho-2271258

ABSTRACT

BACKGROUND: People with certain underlying respiratory and cardiovascular conditions might be at an increased risk for severe illness from COVID-19. Diesel Particulate Matter (DPM) exposure may affect the pulmonary and cardiovascular systems. The study aims to assess if DPM was spatially associated with COVID-19 mortality rates across three waves of the disease and throughout 2020. METHODS: We tested an ordinary least squares (OLS) model, then two global models, a spatial lag model (SLM) and a spatial error model (SEM) designed to explore spatial dependence, and a geographically weighted regression (GWR) model designed to explore local associations between COVID-19 mortality rates and DPM exposure, using data from the 2018 AirToxScreen database. RESULTS: The GWR model found that associations between COVID-19 mortality rate and DPM concentrations may increase up to 77 deaths per 100,000 people in some US counties for every interquartile range (0.21 µg/m3) increase in DPM concentration. Significant positive associations between mortality rate and DPM were observed in New York, New Jersey, eastern Pennsylvania, and western Connecticut for the wave from January to May, and in southern Florida and southern Texas for June to September. The period from October to December exhibited a negative association in most parts of the US, which seems to have influenced the year-long relationship due to the large number of deaths during that wave of the disease. CONCLUSIONS: Our models provided a picture in which long-term DPM exposure may have influenced COVID-19 mortality during the early stages of the disease. That influence appears to have waned over time as transmission patterns evolved.


Subject(s)
COVID-19 , Humans , Seasons , New Jersey , New York , Particulate Matter
4.
Int J Environ Res Public Health ; 20(3)2023 01 20.
Article in English | MEDLINE | ID: covidwho-2245145

ABSTRACT

Increasing acknowledgement of climate change (CC) has encouraged various responses, such as education standard mandates. In 2021, New Jersey (NJ) became the first U.S. state to require K-12 CC education across subjects, effective fall 2022. This necessitated introductory science courses on CC to support high school (HS) curricula. Thus, NJ Safe Schools Program (NJSS) created a new course titled, "Introduction to HS Students to CC, Sustainability, and Environmental Justice (EJ)." Given that the COVID-19 pandemic continues (2020-2023 school years) and vaccination coverage varies, this course was developed and approved in an asynchronous online format. Its five modules cover environmental science, CC, natural disasters and extreme weather events, sustainability, including energy conservation and efficiency definitions, and EJ. A 20-question survey included at the end, modified/adapted from a larger nationwide U.S. Student Conservation Association (SCA) survey 2019-2020, examined the perspectives of HS students concerning CC. Selected volunteer NJ HS enlisted students (n = 82/128 finished) to pilot this course February-April 2022. Results such as average scores ≥90% suggested success regarding initial knowledge and awareness gained; for individual modules, two knowledge checks >80% and three knowledge checks >90%. The SCA survey results, overall and by region in NJ, highlighted how most students felt about CC and extreme weather events, plus issues such as EJ. This NJSS introductory course opened in July 2022 for NJ public county secondary school districts and comprehensive HS with approved career-technical education programs, and potentially elsewhere.


Subject(s)
COVID-19 , Climate Change , Humans , New Jersey , Environmental Justice , Health Knowledge, Attitudes, Practice , Pandemics , COVID-19/epidemiology , Schools , Students
5.
Am J Public Health ; 112(S9): S918-S922, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2141099

ABSTRACT

At-home COVID-19 testing offers convenience and safety advantages. We evaluated at-home testing in Black and Latino communities through an intervention comparing community-based organization (CBO) and health care organization (HCO) outreach. From May through December 2021, 1100 participants were recruited, 94% through CBOs. The odds of COVID-19 test requests and completions were significantly higher in the HCO arm. The results showed disparities in test requests and completions related to age, race, language, insurance, comorbidities, and pandemic-related challenges. Despite the popularity of at-home testing, barriers exist in underresourced communities. (Am J Public Health. 2022;112(S9):S918-S922. https://doi.org/10.2105/AJPH.2022.306989).


Subject(s)
COVID-19 Testing , COVID-19 , Humans , COVID-19/diagnosis , COVID-19/epidemiology , New Jersey , Hispanic or Latino , Delivery of Health Care
6.
Int J Environ Res Public Health ; 19(21)2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2123596

ABSTRACT

COVID-19 has disproportionally impacted Latinx and Black communities in the US. Our study aimed to extend the understanding of ethnic disparities in COVID-19 case rates by using a unique dataset of municipal case rates across New Jersey (NJ) during the first 17 months of the pandemic. We examined the extent to which there were municipal-level ethnic disparities in COVID-19 infection rates during three distinct spikes in case rates over this period. Furthermore, we used the Blinder-Oaxaca decomposition analysis to identify municipal-level exposure and vulnerability factors that contributed to ethnic disparities and how the contributions of these factors changed across the three initial waves of infection. Two clear results emerged. First, in NJ, the COVID-19 infection risk disproportionally affected Latinx communities across all three waves during the first 17 months of the pandemic. Second, the exposure and vulnerability factors that most strongly contributed to higher rates of infection in Latinx and Black communities changed over time as the virus, alongside medical and societal responses to it, also changed. These findings suggest that understanding and addressing ethnicity-based COVID-19 disparities will require sustained attention to the systemic and structural factors that disproportionately place historically marginalized ethnic communities at greater risk of contracting COVID-19.


Subject(s)
COVID-19 , Ethnicity , Humans , United States , COVID-19/epidemiology , Healthcare Disparities , New Jersey/epidemiology , Pandemics
7.
Int J Environ Res Public Health ; 19(23)2022 11 24.
Article in English | MEDLINE | ID: covidwho-2123648

ABSTRACT

COVID-19 quickly spread across the United States (US) while communications and policies at all government levels suffered from inconsistency, misinformation, and lack of coordination. In order to explain the discrepancy between availability and population uptake, a case study was conducted analyzing vaccine rollout plans, social media, and Health Officer/Other Key Informant interviews in New Jersey, New York, and Pennsylvania. Key research questions included, "What were the barriers and facilitators of early COVID vaccine distribution?" and "What mechanisms in the community emerged to alleviate strains in early vaccination?" Findings from this study revealed that pre-existing emergency preparedness infrastructures and plans developed since the 9/11 tragedy were seemingly abandoned. This caused health departments at all levels of government to make impromptu, non-uniform decisions leading to confusion, vaccine hesitancy, and ultimately low uptake. The results indicate that future vaccine rollout best practices must include evidence-based decision-making, coordinated communications, and outreach to high-priority and vulnerable communities.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , New Jersey/epidemiology , New York/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Pennsylvania/epidemiology , Vaccination
8.
J Surg Res ; 284: 264-268, 2023 04.
Article in English | MEDLINE | ID: covidwho-2122648

ABSTRACT

INTRODUCTION: Given the early surge of COVID-19 in New Jersey (NJ), a statewide executive order (EO) to stay-at-home was instituted on March 22, 2020. We hypothesized that the EO would result in a decreased number of trauma admissions, length of stay, and resources utilized in trauma patients at NJ trauma centers. METHODS: In an institutional review board-approved, retrospective, multicenter study, trauma registries at three level one trauma centers in NJ were queried from March 22 to June 14 in 2020 and compared to the same timeframe the year prior. Epidemiological and clinical data were obtained including demographics, select preexisting conditions, mechanism of injury, injury severity score, resources utilized, and outcomes. RESULTS: 1859 trauma patients were evaluated during the EO versus 2201 the year prior. During the EO, trauma patients were less likely to be transferred from another hospital (21% versus 29% P < 0.05), more likely to have a penetrating mechanism (16% versus 12% P < 0.05), were equally likely to require a procedure (P = 0.44) and had similar injury severity score (5 [interquartile range [IQR] 1-9] versus 5 [IQR 1-9], P = 0.73). There was no significant difference in ventilator days (0 [IQR 0-1] versus 0 [IQR 0-2] P = 0.08), intensive care unit days (2 [IQR 0-4] versus 2 [IQR 0-3] P = 0.99), or length of stay (2 [IQR 1-5] versus 2 [IQR 1-6] P = 0.73). Patients were more likely to be sent home than to rehabilitation or long-term acute care hospital during the EO (81% versus 78%, P = 0.02). CONCLUSIONS: The 2020 COVID-19 EO was associated with a significantly different epidemiology with a higher rate of penetrating injury during the EO, and similar volume of injured patients evaluated.


Subject(s)
COVID-19 , Humans , Retrospective Studies , New Jersey/epidemiology , Incidence , COVID-19/epidemiology , Injury Severity Score , Trauma Centers , Length of Stay
9.
Int J Environ Res Public Health ; 19(15)2022 07 29.
Article in English | MEDLINE | ID: covidwho-2023582

ABSTRACT

Identifying potential rapid methods to track COVID-19 trends within schools has become a necessity in understanding how to provide both education and maintain health and safety during a pandemic. This study examined COVID-19 trends and sociodemographic information in New Jersey (NJ) schools during the 2020-2021 school year. A database was compiled for this study in Microsoft Excel using various state and federal resources. Data used in the study are a combination of extracted data from weekly NJ Spotlight reports, weekly NJ COVID-19 Activity Level Index (NJ CALI) reports, and reports of school-based outbreaks via the NJ Department of Health (NJDOH). In 2020-2021, in NJ K-12 schools, the NJDOH defined a school-based outbreak incidence as two or more students and/or adult staff with a laboratory-confirmed positive molecular test for COVID-19 based on transmission occurring on campus. Data were organized into six regions across 21 counties within NJ (3-4 counties per region per NJDOH). COVID-19 trends in NJ schools mirrored trends in their districts, i.e., communities, within the state's region; noticeably, there were consistently high trends during the winter holiday season (November 2020-January 2021). The cumulative number of incidences of school-based outbreaks remained relatively low but, nevertheless, increased throughout the 2020-2021 school year. This study recommends increased accessibility to COVID-19 reports for school and public health officials, and in the future for data to be reported to identify rates of transmission of other communicable diseases within K-12 students, and to further reinforce established mandates and other preventative measures in public while traveling during holiday seasons.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Disease Outbreaks , Humans , New Jersey/epidemiology , Pandemics , Schools
10.
mBio ; 13(5): e0214122, 2022 10 26.
Article in English | MEDLINE | ID: covidwho-2001782

ABSTRACT

Examining the neutralizing capacity of monoclonal antibodies (MAbs) used to treat COVID-19, as well as antibodies recovered from unvaccinated, previously vaccinated, and infected individuals, against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) remains critical to study. Here, we report on a SARS-CoV-2 nosocomial outbreak caused by the SARS-CoV-2 R.1 variant harboring the E484K mutation in a 281-bed psychiatric facility in New Jersey among unvaccinated inpatients and health care professionals (HCPs). A total of 81 inpatients and HCPs tested positive for SARS-Cov-2 by reverse transcription (RT)-PCR from 29 October 9 to 30 November 2020. The R.1 variant exhibits partial or complete resistance to two MAbs in clinical use, as well as 2 receptor binding domain MAbs and 4 N-terminal domain (NTD) MAbs. NTD MAbs against pseudovirus harboring single characteristic R.1 mutations highlight the role of S255F in loss of activity. Additionally, we note dampened neutralization capacity by plasma from individuals with previous SARS-CoV-2 infection or sera from vaccinated individuals. The relative resistance of the R.1 variant is likely lower than that of B.1.351 and closer to that of P.1 and B.1.526. The R.1 lineage has been reported in 47 states in the United States and 40 countries. Although high proportions exhibited symptoms (26% and 61% among patients and HCPs, respectively) and relative antibody resistance, we detected only 10 R.1 variants from over 2,900 samples (~0.34%) collected from January to October 2021. Among 3 vaccinated individuals previously infected with R.1, we observed robust neutralizing antibody responses against SARS-CoV-2 wild type and VOCs. IMPORTANCE The neutralizing capacities of monoclonal antibodies used to treat COVID-19 and of those recovered from previously infected and vaccinated individuals against SARS-CoV-2 variants of concern (VOCs) remain important questions. We report on a nosocomial outbreak caused by a SARS-CoV-2 R.1 variant harboring an E484K mutation among 81 unvaccinated inpatients and health care professionals. We note high attack rates with symptoms in nearly 50% of infected individuals, in sharp contrast to an unrelated institutional outbreak caused by the R.1 variant among a vaccinated population. We found little evidence of significant community spillover. This variant exhibits partial or complete resistance to two monoclonal antibodies in clinical use and dampened the neutralization capacity of convalescent-phase plasma from individuals with previous infection or sera from vaccinated individuals. Among three vaccinated individuals previously infected with R.1, we observed robust neutralizing antibody responses against SARS-CoV-2 wild type and VOCs. These findings underscore the importance of vaccination for prevention of symptomatic COVID-19 disease.


Subject(s)
COVID-19 , Cross Infection , Humans , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , COVID-19/epidemiology , Neutralization Tests , Antibodies, Viral , New Jersey/epidemiology , Antibodies, Neutralizing , Disease Outbreaks , Antibodies, Monoclonal , Genomics
11.
Health Aff (Millwood) ; 41(8): 1125-1132, 2022 08.
Article in English | MEDLINE | ID: covidwho-1974337

ABSTRACT

New Jersey's COVID-19 Temporary Emergency Reciprocity Licensure program provided temporary licenses to more than 31,000 out-of-state health care practitioners. As one of the first COVID-19 hot spots in the US, New Jersey is uniquely positioned to provide insights on enabling an out-of-state health care workforce through temporary licensure to address critical, ongoing concerns about health care workforce supply. In January 2021 we surveyed New Jersey temporary licensees. We analyzed more than 10,000 survey responses and found that practitioners who used the temporary license originated from every state in the US, provided both COVID-19- and non-COVID-19-related care, served a combination of new and existing patients, conversed with patients in at least thirty-six languages, and primarily used telehealth. Findings suggest that temporary licensure of out-of-state practitioners, along with telehealth waivers, may be a valuable, short-term solution to mitigating health care workforce shortages during public health emergencies.


Subject(s)
COVID-19 , Telemedicine , Humans , Licensure , New Jersey , Workforce
12.
Epidemiology ; 33(4): 480-492, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1922357

ABSTRACT

COVID-19 is challenging many societal institutions, including our criminal justice systems. Some have proposed or enacted (e.g., the State of New Jersey) reductions in the jail and/or prison populations. We present a mathematical model to explore the epidemiologic impact of such interventions in jails and contrast them with the consequences of maintaining unaltered practices. We consider infection risk and likely in-custody deaths, and estimate how within-jail dynamics lead to spill-over risks, not only affecting incarcerated people but increasing exposure, infection, and death rates for both corrections officers and the broader community beyond the justice system. We show that, given a typical jail-community dynamic, operating in a business-as-usual way results in substantial, rapid, and ongoing loss of life. Our results are consistent with the hypothesis that large-scale reductions in arrest and speeding of releases are likely to save the lives of incarcerated people, jail staff, and the wider community.


Subject(s)
COVID-19 , Prisoners , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Models, Theoretical , New Jersey/epidemiology
13.
J Community Health ; 47(5): 774-782, 2022 10.
Article in English | MEDLINE | ID: covidwho-1888939

ABSTRACT

Early in the pandemic, New Jersey (NJ) long-term care facilities (LTCFs) witnessed severe COVID-19 illness. With limited surveillance to characterize the scope of infection, we estimated the prevalence of antibody to the SARS-CoV-2 nucleocapsid protein among residents and staff, to describe the epidemiology, and to measure antibody distribution by prior PCR/antigen status and symptomatology. 10 NJ LTCFs of 20 solicited with diverse geography and bed-capacities were visited between October 2020 and March 2021. A single serum was tested for total N-antibody (ELISA) by the state laboratory. Residents' demographics and clinical history were transcribed from the patient record. For staff, this information was solicited directly from employees, supplemented by prior PCR/antigen results from facilities. 62% of 332 residents and 46% of 661 staff tested N-antibody positive. In a multivariable logistic regression in residents, odds ratios for older age and admission prior before March 1, 2020 were significant. Among the staff, odds ratios for older age, ethnic-racial group, nursing-related job, and COVID-19 symptoms were significantly associated with N-antibody positivity. In a sub-analysis in five better record-keeping LTCFs, 90% of residents and 85% of staff with positive PCR/antigen results were seropositive for N-antibody, yet 25% of residents and 22% of staff were N-antibody positive but PCR/antigen and symptoms negative. The high rate of clinically unsuspected infections likely contributed to the spread. These findings argue for robust surveillance, regular screening of asymptomatic individuals, and vaccinating both residents and staff to abate the pandemic. The data also provide guidance to prevent future outbreaks.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Humans , Long-Term Care/methods , New Jersey/epidemiology , Nucleocapsid Proteins , Seroepidemiologic Studies
14.
Gerontologist ; 62(10): 1431-1442, 2022 Nov 30.
Article in English | MEDLINE | ID: covidwho-1860856

ABSTRACT

BACKGROUND AND OBJECTIVES: Age-friendly community initiatives (AFCIs) strive to make localities better for long and healthy lives by fostering improvements across social, physical, and service environments. Despite the heightened need for community supports during the coronavirus disease 2019 pandemic, very little research has addressed the work of AFCIs in the context of this crisis. We aimed to develop theory on how AFCI core teams have contributed to community responses during the pandemic, as well as what contexts have influenced the initiatives' ability to contribute. RESEARCH DESIGN AND METHODS: As part of a multiyear, community-partnered study on the development of philanthropically supported initiatives in northern New Jersey, we conducted qualitative interviews with 8 AFCI core teams during the winter of 2020-2021. The interviews focused on the leaders' efforts at that time, with probing questions concerning enabling factors for their community responses. We analyzed the data using an inductive coding process encompassing open, axial, and subcoding. RESULTS: The analysis indicated four distinct roles of AFC core groups: good community partner, creator, advocate, and communications broker. We further found that AFC leaders primarily drew on three types of capital-human, social, and tangible-to enact these roles, oftentimes in cumulative ways. DISCUSSION AND IMPLICATIONS: We interpret our study's findings and their implications by integrating insights from theories of social impact. We further highlight the importance of continued research on community-centered approaches to promote aging in community during times of societal crisis, and otherwise.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Aging , Communication , New Jersey
15.
Int J Environ Res Public Health ; 19(9)2022 04 28.
Article in English | MEDLINE | ID: covidwho-1820236

ABSTRACT

Epidemiologic evidence indicates exposure to polyfluoroalkyl substances (PFAS) influences immunosuppression, with diminished vaccination response. The relationship between PFAS blood levels and coronavirus disease 2019 (COVID-19) occurrence by age warrants further examination. This assessment identified blood PFAS exposure levels in discrete populations. Recent PFAS population studies summarizing age and gender results were identified and included. Geographically corresponding COVID-19 incidence data were determined for selected counties in North Carolina (NC) and Ohio (OH), and the state of New Jersey (NJ). Centers for Disease Control and Prevention COVID-19 databases were accessed for national incidence data by age groupings. We assessed associations between blood PFAS concentrations, COVID-19 incidence rates, and key demographic characteristics, within subpopulations. COVID-19 incidence counts and blood PFAS concentration were obtained for each age group, along with estimated U.S. Census total population. A general trend observed is higher PFAS levels in older age groups. Younger age groups contained fewer COVID-19 cases. Global COVID-19 mortality is highest in elderly populations with hospitalization and death greatly increasing from age 50. PFAS exposures occurring early in life may cause deleterious health effects later in life, including decreased antibody response and reduced disease resistance. Highest levels of both PFAS exposure and COVID-19 were found in the oldest populations. While this does not determine causality, such associations should help promote further study.


Subject(s)
Alkanesulfonic Acids , COVID-19 , Environmental Pollutants , Fluorocarbons , Aged , COVID-19/epidemiology , Humans , Middle Aged , New Jersey , North Carolina
16.
J Nurs Manag ; 30(6): 1913-1921, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1816607

ABSTRACT

AIM: The aim of this work is to examine staffing, personal protective equipment (PPE) adequacy and physical exhaustion that contributed to burnout and intent to leave among hospital nurses during the first peak of the COVID-19 pandemic. BACKGROUND: Burnout is associated with adverse nurse and patient outcomes. Identifying the magnitude of burnout that occurred during the pandemic can prepare managers for the long-term mental health effects on nurses. METHODS: A cross-sectional, electronic survey was administered to examine perceptions of burnout and intent to leave among all New Jersey hospital nurses from October 6 to October 26, 2020. RESULTS: A total of 3030 nurses responded with 64.3% reporting burnout and 36.5% reporting intent to leave the hospital within a year. There was a significant association between high levels of burnout and intent to leave (χ2  = 329.4; p = .001). There was no association between staffing and burnout; however, reporting inadequate PPE (OR = 1.77 [95% CI: 1.34-2.34]) and physical exhaustion (OR = 3.89 [95% CI: 3.19-4.76]) remained predictors of burnout among nurses. CONCLUSION: Inadequate PPE and physical exhaustion coupled with short staffing contributed to burnout and intent to leave. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should continue to utilize evidence-based mental health interventions and advocate within their nursing professional organizations for relief funds to reduce burnout.


Subject(s)
Burnout, Professional , COVID-19 , Nurses , Nursing Staff, Hospital , Burnout, Professional/complications , Burnout, Professional/etiology , COVID-19/epidemiology , Cross-Sectional Studies , Fatigue/complications , Hospitals , Humans , Job Satisfaction , New Jersey/epidemiology , Nursing Staff, Hospital/psychology , Pandemics , Surveys and Questionnaires , Workplace/psychology
17.
Am J Infect Control ; 50(5): 572-574, 2022 05.
Article in English | MEDLINE | ID: covidwho-1676379

ABSTRACT

Nurses play an important role in the vaccine readiness process and high vaccination rates among nurses are essential to ensuring successful vaccination programs. This study sought to examine whether the intention to get vaccinated varied by race and/or ethnicity among a large sample of registered nurses in New Jersey.


Subject(s)
COVID-19 , Nurses , COVID-19 Vaccines , Cross-Sectional Studies , Humans , New Jersey , SARS-CoV-2 , Vaccination , Vaccination Hesitancy
18.
PLoS One ; 17(1): e0262352, 2022.
Article in English | MEDLINE | ID: covidwho-1606851

ABSTRACT

INTRODUCTION: COVID-19 infection has been hypothesized to precipitate venous and arterial clotting events more frequently than other illnesses. MATERIALS AND METHODS: We demonstrate this increased risk of blood clots by comparing rates of venous and arterial clotting events in 4400 hospitalized COVID-19 patients in a large multisite clinical network in the United States examined from April through June of 2020, to patients hospitalized for non-COVID illness and influenza during the same time period and in 2019. RESULTS: We demonstrate that COVID-19 increases the risk of venous thrombosis by two-fold compared to the general inpatient population and compared to people with influenza infection. Arterial and venous thrombosis were both common occurrences among patients with COVID-19 infection. Risk factors for thrombosis included male gender, older age, and diabetes. Patients with venous or arterial thrombosis had high rates of admission to the ICU, re-admission to the hospital, and death. CONCLUSION: Given the ongoing scientific discussion about the impact of clotting on COVID-19 disease progression, these results highlight the need to further elucidate the role of anticoagulation in COVID-19 patients, particularly outside the intensive care unit setting. Additionally, concerns regarding clotting and COVID-19 vaccines highlight the importance of addressing the alarmingly high rate of clotting events during actual COVID-19 infection when weighing the risks and benefits of vaccination.


Subject(s)
COVID-19/pathology , Thrombosis/pathology , Aged , COVID-19/mortality , Cohort Studies , Comorbidity , Female , Hospitalization , Humans , Male , New Jersey , Retrospective Studies , Thrombosis/mortality , United States
19.
Plast Reconstr Surg ; 149(1): 130e-138e, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1583939

ABSTRACT

BACKGROUND: Since the first documented case of coronavirus disease of 2019 (COVID-19), the greater New York City area quickly became the epicenter of the global pandemic, with over 500,000 cases and 50,000 deaths. This unprecedented crisis affected all aspects of health care, including plastic surgery residency training. The purpose of this study was to understand the specific impact of the COVID-19 pandemic on plastic surgery residencies. METHODS: A survey of all plastic surgery residency training programs in the greater New York City area was conducted. The impact to training during the peak months of infection (March and April of 2020) was evaluated using resident education as measured by case numbers, need for redeployment, and staff wellness as primary outcome variables. RESULTS: A total of 11 programs were identified in the region, and seven programs completed the survey, with a response rate 63.6 percent. When comparing productivity in March and April of 2019 to March and April of 2020, a total decrease in surgical volume of 64.8 percent (range, 19.7 to 84.8 percent) and an average of 940 (range, 50 to 1287) cancelled clinic visits per month were observed. These decreases directly correlated with the local county's COVID-19 incidence rates (p = 0.70). A total of 83 percent of programs required redeployment to areas of need, and correlation between local incidence of COVID-19 and the percentage of residents redeployed to non-plastic surgical clinical environments by a given program (ρ = 0.97) was observed. CONCLUSION: As the first COVID-19 wave passes the greater New York area and spreads to the rest of the country, the authors hope their experience will shed light on the effects of the ongoing COVID-19 pandemic, and inform other programs on what to expect and how they can try and prepare for future public health crises.


Subject(s)
COVID-19/epidemiology , Education, Medical, Graduate/statistics & numerical data , Internship and Residency/standards , Pandemics , Plastic Surgery Procedures/education , Surgery, Plastic/education , Humans , New Jersey/epidemiology , New York City/epidemiology , SARS-CoV-2
20.
Microbiol Spectr ; 9(3): e0188221, 2021 12 22.
Article in English | MEDLINE | ID: covidwho-1522930

ABSTRACT

Emergence of SARS-CoV-2 with high transmission and immune evasion potential, the so-called variants of concern (VOC), is a major concern. We describe the early genomic epidemiology of SARS-CoV-2 recovered from vaccinated health care professionals (HCP). Our postvaccination COVID-19 symptoms-based surveillance program among HCPs in a 17-hospital network identified all vaccinated HCPs who tested positive for COVID-19 after routine screening or after self-reporting. From 1 January 2021 to 30 April 2021, 23,687 HCPs received either mRNA-1273 or BNT162b2 mRNA vaccine. All available postvaccination SARS-CoV-2 samples and a random collection from nonvaccinated patients during the similar time frame were subjected to VOC screening and whole-genome sequencing (WGS). Sixty-two percent (23,697/37,500) of HCPs received at least one vaccine dose, with 60% (22,458) fully vaccinated. We detected 138 (0.58%, 138/23,697) COVID-19 cases, 105 among partially vaccinated and 33 (0.15%, 33/22,458) among fully vaccinated. Five partially vaccinated required hospitalization, four with supplemental oxygen. VOC screening from 16 fully vaccinated HCPs identified 6 (38%) harboring N501Y and 1 (6%) with E484K polymorphisms; percentage of concurrent nonvaccinated samples was 37% (523/1,404) and 20% (284/1,394), respectively. There was an upward trend from January to April for E484K/Q (3% to 26%) and N501Y (1% to 49%). WGS analysis from vaccinated and nonvaccinated individuals indicated highly congruent phylogenies. We did not detect an increased frequency of any receptor-binding domain (RBD)/N-terminal domain (NTD) polymorphism between groups (P > 0.05). Our results support robust protection by vaccination, particularly among recipients of both doses. Despite VOCs accounting for over 40% of SARS-CoV-2 from fully vaccinated individuals, the genomic diversity appears to proportionally represent VOCs among nonvaccinated populations. IMPORTANCE A number of highly effective vaccines have been developed and deployed to combat the COVID-19 pandemic. The emergence and epidemiological dominance of SARS-CoV-2 mutants with high transmission potential and immune evasion properties, the so-called variants of concern (VOC), continue to be a major concern. Whether these VOCs alter the efficacy of the administered vaccines is of great concern and a critical question to study. We describe the initial genomic epidemiology of SARS-CoV-2 recovered from partial/fully vaccinated health care professionals and probe specifically for VOC enrichment. Our findings support the high level of protection provided by full vaccination despite a steep increase in the prevalence of polymorphisms associated with increased transmission potential (N501Y) and immune evasion (E484K) in the nonvaccinated population. Thus, we do not find evidence of VOC enrichment among vaccinated groups. Overall, the genomic diversity of SARS-CoV-2 recovered postvaccination appears to proportionally represent the observed viral diversity within the community.


Subject(s)
COVID-19 Vaccines , COVID-19/epidemiology , Epidemiologic Studies , Genomics , Health Personnel , Molecular Epidemiology , SARS-CoV-2/genetics , Vaccination , 2019-nCoV Vaccine mRNA-1273 , Adult , Aged , BNT162 Vaccine , COVID-19/virology , Female , Genotype , Humans , Male , Middle Aged , Mutation , New Jersey , Pandemics , SARS-CoV-2/classification , SARS-CoV-2/isolation & purification , Spike Glycoprotein, Coronavirus , Whole Genome Sequencing , Young Adult
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