Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol.

Introduction: The long-term impact of COVID-19 is unknown. We developed a 5-year prospective cohort study designed to generate actionable community-informed research about the consequences of COVID-19 on adolescents ages 12-17 years in Arizona. Methods: The study has two primary outcomes: 1) acute and long-term outcomes of COVID-19 illness and 2) symptoms of depression and anxiety. Data is collected using an online survey with plans to integrate qualitative data collection methods. The survey is administered at baseline, 4, and 8 months in year one, and annually in years two through five. This study is informed by Intersectionality Theory, which considers the diverse identities adolescents have that are self and socially defined and the influence they have collectively and simultaneously. To this end, a sample of variables collected is race/ethnicity, language usage, generational status, co-occurring health conditions, and gender. Additional measures capture experiences in social contexts such as home (parent employment, food, and housing security), school (remote learning, type of school), and society (racism). Results: Findings are not presented because the manuscript is a protocol designed to describe the procedure instead of report results. Discussion: The unique contributions of the study is its focus on COVID-19 the illness and COVID-19 the socially experienced pandemic and the impact of both on adolescents.

Baseline Sequencing Surveillance of Public Clinical Testing, Hospitals, and Community Wastewater Reveals Rapid Emergence of SARS-CoV-2 Omicron Variant of Concern in Arizona, USA.

The adaptive evolution of SARS-CoV-2 variants is driven by selection for increased viral fitness in transmissibility and immune evasion. Understanding the dynamics of how an emergent variant sweeps across populations can better inform public health response preparedness for future variants. Here, we investigated the state-level genomic epidemiology of SARS-CoV-2 through baseline genomic sequencing surveillance of 27,071 public testing specimens and 1,125 hospital inpatient specimens diagnosed between November 1, 2021, and January 31, 2022, in Arizona. We found that the Omicron variant rapidly displaced Delta variant in December 2021, leading to an "Omicron surge" of COVID-19 cases in early 2022. Wastewater sequencing surveillance of 370 samples supported the synchronous sweep of Omicron in the community. Hospital inpatient COVID-19 cases of Omicron variant presented to three major hospitals 10.51 days after its detection from public clinical testing. Nonsynonymous mutations in nsp3, nsp12, and nsp13 genes were significantly associated with Omicron hospital cases compared to community cases. To model SARS-CoV-2 transmissions across the state population, we developed a scalable sequence network methodology and showed that the Omicron variant spread through intracounty and intercounty transmissions. Finally, we demonstrated that the temporal emergence of Omicron BA.1 to become the dominant variant (17.02 days) was 2.3 times faster than the prior Delta variant (40.70 days) or subsequent Omicron sublineages BA.2 (39.65 days) and BA.5 (35.38 days). Our results demonstrate the uniquely rapid sweep of Omicron BA.1. These findings highlight how integrated public health surveillance can be used to enhance preparedness and response to future variants. IMPORTANCE SARS-CoV-2 continues to evolve new variants throughout the pandemic. However, the temporal dynamics of how SARS-CoV-2 variants emerge to become the dominant circulating variant is not precisely known. Genomic sequencing surveillance offers unique insights into how SARS-CoV-2 spreads in communities and the lead-up to hospital cases during a surge. Specifically, baseline sequencing surveillance through random selection of positive diagnostic specimens provides a representative outlook of the virus lineages circulating in a geographic region. Here, we investigated the emergence of the Omicron variant of concern in Arizona by leveraging baseline genomic sequence surveillance of public clinical testing, hospitals, and community wastewater. We tracked the spread and evolution of the Omicron variant as it first emerged in the general public, and its rapid shift in hospital admissions in the state health system. This study demonstrates the timescale of public health preparedness needed to respond to an antigenic shift in SARS-CoV-2.

Racial/ethnic disparities in influenza risk perception and vaccination intention among Pima County residents in Arizona.

While influenza cases in Arizona have nearly tripled since 2018, vaccination rates continue to lag. Statewide, Hispanics and African Americans had the lowest vaccination rates despite having higher influenza infection rates than Whites. Given Arizona's racial influenza vaccination disparity and the general increase in vaccination hesitancy due to COVID-19, the purpose of this study was to better understand the influences of seasonal influenza vaccination in Arizona during the COVID-19 pandemic using qualitative methods. Findings from this study revealed that many participants were motivated to get the influenza vaccine to protect their family and close friends. The heightened concern for COVID-19 prompted some Hispanic/Latino focus group discussion participants to consider getting vaccinated. However, many Hispanic/Latino participants also expressed that they stopped getting influenza vaccine due to negative vaccination experiences or concern about sickness following immunization. African American participants primarily discussed receiving the vaccine as part of their routine health visit. Compared to other races, more White participants believed that vaccination was unimportant because they were healthy, and the people they interacted with never got sick. Distinct factors influence risk perception and vaccination intention across different racial/ethnic groups. Effective interventions can account for these factors and be tailored to the target population to maximize vaccination uptake.

One health genomic surveillance and response to a university-based outbreak of the SARS-CoV-2 Delta AY.25 lineage, Arizona, 2021.

Genomic surveillance and wastewater tracking strategies were used to strengthen the public health response to an outbreak of the SARS-CoV-2 Delta AY.25 lineage associated with a university campus in Arizona. Epidemiologic and clinical data routinely gathered through contact tracing were matched to SARS-CoV-2 genomes belonging to an outbreak of AY.25 identified through ongoing phylogenomic analyses. Continued phylogenetic analyses were conducted to further describe the AY.25 outbreak. Wastewater collected twice weekly from sites across campus was tested for SARS-CoV-2 by RT-qPCR, and subsequently sequenced to identify variants. The AY.25 outbreak was defined by a single mutation (C18804T) and comprised 379 genomes from SARS-CoV-2 positive cases associated with the university and community. Several undergraduate student gatherings and congregate living settings on campus likely contributed to the rapid spread of COVID-19 across the university with secondary transmission into the community. The clade defining mutation was also found in wastewater samples collected from around student dormitories a week before the semester began, and 9 days before cases were identified. Genomic, epidemiologic, and wastewater surveillance provided evidence that an AY.25 clone was likely imported into the university setting just prior to the onset of the Fall 2021 semester, rapidly spread through a subset of the student population, and then subsequent spillover occurred in the surrounding community. The university and local public health department worked closely together to facilitate timely reporting of cases, identification of close contacts, and other necessary response and mitigation strategies. The emergence of new SARS-CoV-2 variants and potential threat of other infectious disease outbreaks on university campuses presents an opportunity for future comprehensive One Health genomic data driven, targeted interventions.

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID.

OBJECTIVE: To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. METHODS: This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. RESULTS: Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. CONCLUSIONS: MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

Making Vaccines Equitably Available to All Persons in Pima County, Arizona, 2020-2021.

We review the Pima County (Arizona) Health Department's efforts to achieve equitable COVID-19 vaccine distribution in a county with a social vulnerability index of 0.88. We expedited vaccine distribution, focusing on equitable distribution, implementing a multi-point of dispensing approach, and using a periurban and rural strategy. Pima County has one of the highest vaccine distribution percentages among the highest social vulnerability index quartiles and is more than 10 percentage points ahead of other large counties in Arizona in vaccine uptake. (Am J Public Health. 2022;112(11):1560-1563. https://doi.org/10.2105/AJPH.2022.307040).

Novel chaotic oppositional fruit fly optimization algorithm for feature selection applied on COVID 19 patients' health prediction.

The fast-growing quantity of information hinders the process of machine learning, making it computationally costly and with substandard results. Feature selection is a pre-processing method for obtaining the optimal subset of features in a data set. Optimization algorithms struggle to decrease the dimensionality while retaining accuracy in high-dimensional data set. This article proposes a novel chaotic opposition fruit fly optimization algorithm, an improved variation of the original fruit fly algorithm, advanced and adapted for binary optimization problems. The proposed algorithm is tested on ten unconstrained benchmark functions and evaluated on twenty-one standard datasets taken from the Univesity of California, Irvine repository and Arizona State University. Further, the presented algorithm is assessed on a coronavirus disease dataset, as well. The proposed method is then compared with several well-known feature selection algorithms on the same datasets. The results prove that the presented algorithm predominantly outperform other algorithms in selecting the most relevant features by decreasing the number of utilized features and improving classification accuracy.

The Arizona Prevention Research Center partnerships in Arizona to promote COVID-19 vaccine health equity.

Background: Vaccine hesitancy in the face of the COVID-19 pandemic is a complex issue that undermines our national ability to reduce the burden of the disease and control the pandemic. The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity and mortality among Arizona's Latinx rural, underserved, farmworker, disabled and elderly populations. In March 2021, ~8.1% of those vaccinated were Latinx, though Latinxs make up 32% of Arizona's population. The Arizona Vaccine Confidence Network (AzVCN) proposed to leverage the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 vaccines. Methods: The AzVCN focused efforts on Latinx, rural, un/underinsured and farmworker communities in the four Arizona border counties that are at greater risk of COVID-19 morbidity and mortality and may have limited access to vaccination and other essential health services. The AzVCN used listening sessions to create a feedback loop with key stakeholders and critical health care workers to validate barriers/enablers and identify solutions to increase vaccination uptake emerging from the network. The AzVCN also implemented a community-based intervention using community health workers (CHWs) based in a MHU to increase knowledge of the COVID-19 vaccines, reduce vaccination hesitancy and increase vaccination uptake among Latinx rural, un/underinsured and farmworker populations in Southern Arizona. Results: AzVCN outcomes include: identification of enablers and barriers of COVID-19 vaccination in the priority populations; identification of strategies and solutions to address vaccine hesitancy and increase vaccine uptake among priority population; and evidence that the proposed solutions being tested through the AzVCN contribute to increased vaccine uptake among the priority populations. Conclusion: Through these efforts the AzPRC contributed to the CDC's Vaccinate with Confidence Strategy by collaborating with CHWs and other key stakeholders to engage directly with communities in identifying and addressing structural and misinformation barriers to vaccine uptake.

Community Conversations About COVID-19.

"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.

Persisting gastrointestinal symptoms and post-infectious irritable bowel syndrome following SARS-CoV-2 infection: results from the Arizona CoVHORT.

In this study, we aimed to examine the association between gastrointestinal (GI) symptom presence during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the prevalence of GI symptoms and the development of post-infectious irritable bowel syndrome (PI-IBS). We used data from a prospective cohort and logistic regression to examine the association between GI symptom status during confirmed SARS-CoV-2 infection and prevalence of persistent GI symptoms at ≥45 days. We also report the incidence of PI-IBS following SARS-CoV-2 infection. Of the 1475 participants in this study, 33.8% (n = 499) had GI symptoms during acute infection. Cases with acute GI symptoms had an odds of persisting GI symptoms 4 times higher than cases without acute GI symptoms (odds ratio (OR) 4.29, 95% confidence interval (CI) 2.45-7.53); symptoms lasted on average 8 months following infection. Of those with persisting GI symptoms, 67% sought care for their symptoms and incident PI-IBS occurred in 3.0% (n = 15) of participants. Those with acute GI symptoms after SARS-CoV-2 infection are likely to have similar persistent symptoms 45 days and greater. These data indicate that attention to a potential increase in related healthcare needs is warranted.

University-Associated SARS-CoV-2 Omicron BA.2 Infections, Maricopa County, Arizona, USA, 2022.

We investigated a university-affiliated cohort of SARS-CoV-2 Omicron BA.2 infections in Arizona, USA. Of 44 cases, 43 were among students; 26 persons were symptomatic, 8 sought medical care, but none were hospitalized. Most (55%) persons had completed a primary vaccine series; 8 received booster vaccines. BA.2 infection was mild in this young cohort.

Clinical outcomes of monoclonal antibody therapy during a COVID-19 outbreak in a skilled nursing facility-Arizona, 2021.

BACKGROUND: Adult residents of skilled nursing facilities (SNF) have experienced high morbidity and mortality from SARS-CoV-2 infection and are at increased risk for severe COVID-19 disease. Use of monoclonal antibody (mAb) treatment improves clinical outcomes among high-risk outpatients with mild-to-moderate COVID-19, but information on mAb effectiveness in SNF residents with COVID-19 is limited. We assessed outcomes in SNF residents with mild-to-moderate COVID-19 associated with an outbreak in Arizona during January-February 2021 that did and did not receive a mAb. METHODS: Medical records were reviewed to describe the effect of bamlanivimab therapy on COVID-19 mortality. Secondary outcomes included referral to an acute care setting and escalation of medical therapies at the SNF (e.g., new oxygen requirements). Residents treated with bamlanivimab were compared to residents who were eligible for treatment under the FDA's Emergency Use Authorization (EUA) but were not treated. Multivariable logistic regression was used to determine association between outcomes and treatment status. RESULTS: Seventy-five residents identified with COVID-19 during this outbreak met eligibility for mAb treatment, of whom 56 received bamlanivimab. Treated and untreated groups were similar in age and comorbidities associated with increased risk of severe COVID-19 disease. Treatment with bamlanivimab was associated with reduced 21-day mortality (adjusted OR = 0.06; 95% CI: 0.01, 0.39) and lower odds of initiating oxygen therapy (adjusted OR = 0.07; 95% CI: 0.02, 0.34). Referrals to acute care were not significantly different between treated and untreated residents. CONCLUSIONS: mAb therapy was successfully administered to SNF residents with COVID-19 in a large outbreak setting. Treatment with bamlanivimab reduced 21-day mortality and reduced initiation of oxygen therapy. As the COVID-19 pandemic evolves and newer immunotherapies gain FDA authorization, more studies of the effectiveness of mAb therapies for treating emerging SARS-CoV-2 variants of concern in high-risk congregate settings are needed.

The seroprevalence of SARS-CoV-2 in a rural southwest community.

Context: The true prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has been difficult to determine due to limited testing, inconsistent symptom severity, and asymptomatic infections. Systematic investigation of the prevalence of SARS-CoV-2 has been limited to urban environments and large academic centers. Limited data on the seroprevalence of SARS-CoV-2 is available for those who live in a rural community setting, leaving rural practitioners to extrapolate the epidemiology of COVID-19 to a nonhomogeneous population. Objective: To determine the seroprevalence of SARS-CoV-2 in a community setting. The secondary objective of this study was to describe the difference in infection rate and reverse transcription polymerase chain reaction (RT-PCR) testing in the same rural community. Methods: A prospective convenience sample of community members and healthcare workers from the Kingman, Arizona area were tested for SARS-CoV-2-specific antibodies using a lateral flow immunoassay with the VITROS Anti-SARS-CoV-2 IgG test (Ortho-Clinical Diagnostics, Inc.) from September 28, 2020 to October 09, 2020. Upon recruitment, participants were asked to complete a demographic survey assessing socioeconomic status, comorbidities, and COVID-19 symptoms in the preceding two months. Following enrollment, a retrospective chart review was completed to determine the percentage of patients who had undergone previous SARS-CoV-RT-PCR testing. Results: A total of 566 participants were included in the final analysis: 380 (67.1%) were women, 186 (32.9%) were men, a majority (458; 80.9%) self-identified as White, and 303 (53.5%) were employed as healthcare professionals. Seroprevalence of SARS-CoV-2 was found to be 8.0% (45 of 566) across the sample and 9.9% (30 of 303) in healthcare workers. No statistical difference in seroprevalence was found between men and women, healthcare workers and other participants, amongst racial groups, by socioeconomic status, by comorbid conditions, or by education level. Among the participants, 108 (19.1%) underwent previous RT-PCR testing. Of the 45 patients who were antibody positive, 27 (60%) had received a previous RT-PCR test, with 20 (44.4%) testing positive for SARS-CoV-2. Participants with symptoms of anosmia/ageusia (p<0.001), chest congestion (p=0.047), fever (p=0.007), and shortness of breath (p=0.002) within the past two months were more likely to have antibodies to SARS-CoV-2. Conclusion: Only 8% of 566 participants in this rural community setting were found to have antibodies for SARS-CoV-2. A large minority (18; 40%) of patients testing seropositive for SARs-CoV-2 had never received a prior test, suggesting that the actual rates of infection are higher than publicly available data suggest. Further large-scale antibody testing is needed to determine the true prevalence of SARS-CoV-2 in the rural setting.

Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites - Pima County, Arizona, November 3-17, 2020.

Rapid antigen tests, such as the Abbott BinaxNOW COVID-19 Ag Card (BinaxNOW), offer results more rapidly (approximately 15-30 minutes) and at a lower cost than do highly sensitive nucleic acid amplification tests (NAATs) (1). Rapid antigen tests have received Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for use in symptomatic persons (2), but data are lacking on test performance in asymptomatic persons to inform expanded screening testing to rapidly identify and isolate infected persons (3). To evaluate the performance of the BinaxNOW rapid antigen test, it was used along with real-time reverse transcription-polymerase chain reaction (RT-PCR) testing to analyze 3,419 paired specimens collected from persons aged ≥10 years at two community testing sites in Pima County, Arizona, during November 3-17, 2020. Viral culture was performed on 274 of 303 residual real-time RT-PCR specimens with positive results by either test (29 were not available for culture). Compared with real-time RT-PCR testing, the BinaxNOW antigen test had a sensitivity of 64.2% for specimens from symptomatic persons and 35.8% for specimens from asymptomatic persons, with near 100% specificity in specimens from both groups. Virus was cultured from 96 of 274 (35.0%) specimens, including 85 (57.8%) of 147 with concordant antigen and real-time RT-PCR positive results, 11 (8.9%) of 124 with false-negative antigen test results, and none of three with false-positive antigen test results. Among specimens positive for viral culture, sensitivity was 92.6% for symptomatic and 78.6% for asymptomatic individuals. When the pretest probability for receiving positive test results for SARS-CoV-2 is elevated (e.g., in symptomatic persons or in persons with a known COVID-19 exposure), a negative antigen test result should be confirmed by NAAT (1). Despite a lower sensitivity to detect infection, rapid antigen tests can be an important tool for screening because of their quick turnaround time, lower costs and resource needs, high specificity, and high positive predictive value (PPV) in settings of high pretest probability. The faster turnaround time of the antigen test can help limit transmission by more rapidly identifying infectious persons for isolation, particularly when used as a component of serial testing strategies.

Effectiveness of Physical Distancing: Staying 6 Feet Over to Put Respiratory Viruses 6 Feet Under.

Community transmission of severe acute respiratory illness Coronavirus-2 (SARS-CoV-2) in Arizona was noted in March 2020. It was our hypothesis that the associated implementation of physical distancing and masking led to a decline in circulation and detection of common respiratory viruses. Nasopharyngeal swabs processed with the Biofire, Film Array respiratory panel at Mayo Clinic Arizona were reviewed from January 1, 2017, to July 31, 2020. A total of 13,324 nasopharyngeal swabs were analyzed. Between April and July 2017- 2019 (Period A) a mean of 262 tests were performed monthly, falling to 128 for the corresponding months of 2020 (Period B). A reduction in the monthly mean number of positive tests (Period A 71.5; Period B 2.8) and mean positivity rate (Period A 25.04%; Period B 2.07%) was observed. Rhinovirus/enterovirus was the most prevalent virus, with a monthly mean of 21.6 cases (30.2% of positives) for Period A and 2 cases (72.7% of positives) for Period B. Positivity for a second virus occurred in a mean of 2.1 positive tests (3.3%) in Period A but was absent in Period B. Implementation of distancing and masking coincides with a marked reduction in respiratory virus detection and likely circulation. Data from the fall/winter of 2020 will help clarify the potential role for distancing and masking as a mitigation strategy, not only for SARS-CoV-2 but also in the seasonal battle against common respiratory viruses.

COVID-19 Exposure Among First Responders in Arizona.

OBJECTIVE: The number of COVID-19 cases in Arizona is rapidly increasing, leading the country in the rate of new daily cases. Exposure among first responders remains unknown. METHODS: Rates of SARS-CoV-2 IgG among first responders in Arizona were determined, and attitudes/views about the impact of COVID-19 on their work life was analyzed. RESULTS: Of 3326 first responders, 50 (1.50%) tested positive for SARS-CoV-2 IgG. Most first responders thought antibody testing would help ease their anxieties (62.5%) and be beneficial to their work-life (60.6%). CONCLUSION: The rate of COVID-19 exposure among first responders in Arizona is low-1.50%. COVID-19 is a concern among many of the first responders, and antibody testing was beneficial in easing their anxieties about going to work and performing work-related duties.

US Rural Surgeons Leading During COVID-19: Where Are They Now?

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.

COVID-19 healthcare demand projections: Arizona.

Beginning in March 2020, the United States emerged as the global epicenter for COVID-19 cases with little to guide policy response in the absence of extensive data available for reliable epidemiological modeling in the early phases of the pandemic. In the ensuing weeks, American jurisdictions attempted to manage disease spread on a regional basis using non-pharmaceutical interventions (i.e., social distancing), as uneven disease burden across the expansive geography of the United States exerted different implications for policy management in different regions. While Arizona policymakers relied initially on state-by-state national modeling projections from different groups outside of the state, we sought to create a state-specific model using a mathematical framework that ties disease surveillance with the future burden on Arizona's healthcare system. Our framework uses a compartmental system dynamics model using a SEIRD framework that accounts for multiple types of disease manifestations for the COVID-19 infection, as well as the observed time delay in epidemiological findings following public policy enactments. We use a compartment initialization logic coupled with a fitting technique to construct projections for key metrics to guide public health policy, including exposures, infections, hospitalizations, and deaths under a variety of social reopening scenarios. Our approach makes use of X-factor fitting and backcasting methods to construct meaningful and reliable models with minimal available data in order to provide timely policy guidance in the early phases of a pandemic.

Brain donation in the era of COVID 19: challenges to the harvest in the face of a pandemic.

We have experienced numerous new challenges during the process of brain harvesting in the period of COVID-19. Although brain harvests have continued successfully during this time period, the numerous uncertainties and challenges described in this paper have nearly derailed the process several times. While the interface of the medical profession with patients in the context of a pandemic has been well-documented on several fronts, and particularly for those health care workers on the front lines, we are not aware of any documentary accounts of the challenges facing research and tissue donation programs. With this paper, we contribute an additional perspective and describe the lessons we have learned in addressing these novel issues.