Multiregional, multi-industry impacts of fairness on pandemic policies.

The health and economic crisis caused by the COVID-19 pandemic highlights the necessity for a deeper understanding and investigation of state- and industry-level mitigation policies. While different control strategies in the early stages, such as lockdowns and school and business closures, have helped decrease the number of infections, these strategies have had an adverse economic impact on businesses and some controversial impacts on social justice. Therefore, optimal timing and scale of closure and reopening strategies are required to prevent both different waves of the pandemic and the negative socioeconomic impact of control strategies. This article proposes a novel multiobjective mixed-integer linear programming formulation, which results in the optimal timing of closure and reopening of states and industries in each. The three objectives being pursued include: (i) the epidemiological impact of the pandemic in terms of the percentage of the infected population; (ii) the social vulnerability index of the pandemic policy based on the vulnerability of communities to getting infected, and for losing their job; and (iii) the economic impact of the pandemic based on the inoperability of industries in each state. The proposed model is implemented on a dataset that includes 50 states, the District of Columbia, and 19 industries in the United States. The Pareto-optimal solutions suggest that for any control decision (state and industry closure or reopening), the economic impact and the epidemiological impact change in the opposite direction.

Efficacy and Safety of Anakinra Plus Standard of Care for Patients With Severe COVID-19: A Randomized Phase 2/3 Clinical Trial.

Importance: COVID-19 pneumonia is often associated with hyperinflammation. The efficacy and safety of anakinra in treating patients with severe COVID-19 pneumonia and hyperinflammation are still unclear. Objective: To assess the efficacy and safety of anakinra vs standard of care alone for patients with severe COVID-19 pneumonia and hyperinflammation. Design, Setting, and Participants: The Clinical Trial of the Use of Anakinra in Cytokine Storm Syndrome Secondary to COVID-19 (ANA-COVID-GEAS) was a multicenter, randomized, open-label, 2-group, phase 2/3 clinical trial conducted at 12 hospitals in Spain between May 8, 2020, and March 1, 2021, with a follow-up of 1 month. Participants were adult patients with severe COVID-19 pneumonia and hyperinflammation. Hyperinflammation was defined as interleukin-6 greater than 40 pg/mL, ferritin greater than 500 ng/mL, C-reactive protein greater than 3 mg/dL (rationale, ≥5 upper normal limit), and/or lactate dehydrogenase greater than 300 U/L. Severe pneumonia was considered if at least 1 of the following conditions was met: ambient air oxygen saturation 94% or less measured with a pulse oximeter, ratio of partial pressure O2 to fraction of inspired O2 of 300 or less, and/or a ratio of O2 saturation measured with pulse oximeter to fraction of inspired O2 of 350 or less. Data analysis was performed from April to October 2021. Interventions: Usual standard of care plus anakinra (anakinra group) or usual standard of care alone (SoC group). Anakinra was given at a dose of 100 mg 4 times a day intravenously. Main Outcomes and Measures: The primary outcome was the proportion of patients not requiring mechanical ventilation up to 15 days after treatment initiation, assessed on an intention-to-treat basis. Results: A total of 179 patients (123 men [69.9%]; mean [SD] age, 60.5 [11.5] years) were randomly assigned to the anakinra group (92 patients) or to the SoC group (87 patients). The proportion of patients not requiring mechanical ventilation up to day 15 was not significantly different between groups (64 of 83 patients [77.1%] in the anakinra group vs 67 of 78 patients [85.9%] in the SoC group; risk ratio [RR], 0.90; 95% CI, 0.77-1.04; P = .16). Anakinra did not result in any difference in time to mechanical ventilation (hazard ratio, 1.72; 95% CI, 0.82-3.62; P = .14). There was no significant difference between groups in the proportion of patients not requiring invasive mechanical ventilation up to day 15 (RR, 0.99; 95% CI, 0.88-1.11; P > .99). Conclusions and Relevance: In this randomized clinical trial, anakinra did not prevent the need for mechanical ventilation or reduce mortality risk compared with standard of care alone among hospitalized patients with severe COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov Identifier: NCT04443881.

Modeling social, economic, and health perspectives for optimal pandemic policy decision-making.

While different control strategies in the early stages of the COVID-19 pandemic have helped decrease the number of infections, these strategies have had an adverse economic impact on businesses. Therefore, optimal timing and scale of closure and reopening strategies are required to prevent both different waves of the pandemic and the negative economic impact of control strategies. This paper proposes a novel multi-objective mixed-integer linear programming (MOMILP) formulation, which results in the optimal timing of closure and reopening of states and industries in each state to mitigate the economic and epidemiological impact of a pandemic. The three objectives being pursued include: (i) the epidemiological impact, (ii) the economic impact on the local businesses, and (iii) the economic impact on the trades between industries. The proposed model is implemented on a dataset that includes 11 states, the District of Columbia, and 19 industries in the US. The solved by augmented ε-constraint approach is used to solve the multi-objective model, and a final strategy is selected from the set of Pareto-optimal solutions based on the least cubic distance of the solution from the optimal value of each objective. The Pareto-optimal solutions suggest that for any control decision (state and industry closure or reopening), the economic impact and the epidemiological impact change in the opposite direction, and it is more effective to close most states while keeping the majority of industries open during the planning horizon.

Priming With Rhinovirus Protects Mice Against a Lethal Pulmonary Coronavirus Infection.

Rhinoviruses (RV) have been shown to inhibit subsequent infection by heterologous respiratory viruses, including influenza viruses and severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). To better understand the mechanisms whereby RV protects against pulmonary coronavirus infection, we used a native murine virus, mouse hepatitis virus strain 1 (MHV-1), that causes severe disease in the lungs of infected mice. We found that priming of the respiratory tract with RV completely prevented mortality and reduced morbidity of a lethal MHV-1 infection. Replication of MHV-1 was reduced in RV-primed mouse lungs although expression of antiviral type I interferon, IFN-ß, was more robust in mice infected with MHV-1 alone. We further showed that signaling through the type I interferon receptor was required for survival of mice given a non-lethal dose of MHV-1. RV-primed mice had reduced pulmonary inflammation and hemorrhage and influx of leukocytes, especially neutrophils, in the airways upon MHV-1 infection. Although MHV-1 replication was reduced in RV-primed mice, RV did not inhibit MHV-1 replication in coinfected lung epithelial cells in vitro. In summary, RV-mediated priming in the respiratory tract reduces viral replication, inflammation, and tissue damage, and prevents mortality of a pulmonary coronavirus infection in mice. These results contribute to our understanding of how distinct respiratory viruses interact with the host to affect disease pathogenesis, which is a critical step in understanding how respiratory viral coinfections impact human health.

Association between COVID-19 related elective surgery cancellations and pediatric inguinal hernia complications: A nationwide multicenter cohort study.

BACKGROUND: Optimal inguinal hernia repair timing remains controversial. It remains unclear how COVID-19 related elective surgery cancellations impacted timing of inguinal hernia repair and whether any delays led to complications. This study aims to determine whether elective surgery cancellations are safe in pediatric inguinal hernia. METHODS: This multicenter retrospective cohort study at 14 children's hospitals included patients ≤18 years who underwent inguinal hernia repair between September 13, 2019, through September 13, 2020. Patients were categorized by whether their inguinal hernia repair occurred before or after their hospital's COVID-19 elective surgery cancellation date. Incarceration and emergency department encounters were compared between pre and postcancellation. RESULTS: Of 1,404 patients, 604 (43.0%) underwent inguinal hernia repair during the postcancellation period, 92 (6.6%) experienced incarceration, and 213 (15.2%) had an emergency department encounter. The postcancellation period was not associated with incarceration (odds ratio 1.54; 95% confidence interval 0.88-2.71; P = .13) or emergency department encounters (odds ratio 1.53; 95% confidence interval 0.94-2.48; P = .09) despite longer median times to inguinal hernia repair (precancellation 29 days [interquartile range 13-55 days] versus postcancellation 31 days [interquartile range 14-73 days], P = .01). Infants were more likely to have the emergency department be their index presentation in the postcancellation period (odds ratio 1.69; 95% confidence interval 1.24-2.31; P < .01). CONCLUSION: Overall, COVID-19 elective surgery cancellations do not appear to increase the likelihood of incarceration or emergency department encounters despite delays in inguinal hernia repair, suggesting that cancellations are safe in children with inguinal hernia. Assessment of elective surgery cancellation safety has important implications for health policy.

Coverage Path Planning with Semantic Segmentation for UAV in PV Plants

Solar energy is one of the most strategic energy sources for the world’s economic development. This has caused the number of solar photovoltaic plants to increase around the world;consequently, they are installed in places where their access and manual inspection are arduous and risky tasks. Recently, the inspection of photovoltaic plants has been conducted with the use of unmanned aerial vehicles (UAV). Although the inspection with UAVs can be completed with a drone operator, where the UAV flight path is purely manual or utilizes a previously generated flight path through a ground control station (GCS). However, the path generated in the GCS has many restrictions that the operator must supply. Due to these restrictions, we present a novel way to develop a flight path automatically with coverage path planning (CPP) methods. Using a DL server to segment the region of interest (RoI) within each of the predefined PV plant images, three CPP methods were also considered and their performances were assessed with metrics. The UAV energy consumption performance in each of the CPP methods was assessed using two different UAVs and standard metrics. Six experiments were performed by varying the CPP width, and the consumption metrics were recorded in each experiment. According to the results, the most effective and efficient methods are the exact cellular decomposition boustrophedon and grid-based wavefront coverage, depending on the CPP width and the area of the PV plant. Finally, a relationship was established between the size of the photovoltaic plant area and the best UAV to perform the inspection with the appropriate CPP width. This could be an important result for low-cost inspection with UAVs, without high-resolution cameras on the UAV board, and in small plants.

Psychosis associated with suspected SARS-CoV-2 encephalitis with response to steroids: a case report.

INTRODUCTION: The SARS-Cov-2 infection has multiple neurologic manifestations including encephalitis in multiple cases reported, however the psychosis as principal manifestation of this condition is infrequently. CASE REPORT: We report the case of a 48-year-old woman with a confirmed diagnosis of SARS-CoV-2 who developed paranoid and self-referential ideas with behavioural alteration and multiple findings on mental examination. Encephalitis associated with Covid-19 was suspected due to the neurological clinical presentation (persistent despite resolve hypoxaemia and systemic symptoms) and brain magnetic resonance image (MRI) that showed asymmetric hippocampal hyperintensities, although cerebrospinal fluid and electroencephalogram (EEG) were normal. The patient received medical treatment with methylprednisolone for 5 days with complete resolution of her symptoms. DISCUSSION: The current SARS-CoV-2 pandemic has neurological complications either by direct involvement or by para-infectious or post-infectious phenomena. Encephalitis occurs in a small proportion of the cases, while psychiatric symptoms have been described in a variable percentage of the events. However, a psychotic picture such as the one reported in our case is unusual. MRI, cerebrospinal fluid and EEG are important for the diagnostic evaluation of these patients but not obligatory to the diagnosis. The treatment of this condition with corticosteroids has been successful even in cases associated with Anti-NMDA. Our case is the second reported in Colombia, the first to be associated with psychosis.

Intent to Vaccinate SARS-CoV-2 Infected Children in US Households: A Survey.

A paucity of data exists evaluating a guardian's intent to vaccinate their child against COVID-19 in the United States. We administered 102 first (April-November 2020) and 45 second (December-January 2020-2021) surveys to guardians of children (<18 years) who had a laboratory-confirmed diagnosis of COVID-19 and assessed their intent to give a COVID-19 vaccine to their child, when one becomes available. The first and second surveys of the same cohort of guardians were conducted before and following the press releases detailing the adult Pfizer-BioNTech and Moderna Phase 3 results. Both surveys included an intent-to-vaccinate question using the subjective language of "if a safe and effective vaccine" became available, and a second question was added to second surveys using the objective language of "would prevent 19 of 20 people from getting disease". When using subjective language, 24 of 45 (53%) guardians endorsed vaccine administration for their children in the first survey, which decreased to 21 (46%) in the second survey. When adding objective language, acceptance of vaccination increased to 31 (69%, p = 0.03). Common reasons for declining vaccination were concerns about adverse effects and/or vaccine safety. Providing additional facts on vaccine efficacy increased vaccine acceptance. Evidence-based strategies are needed to increase pediatric COVID-19 vaccine uptake.

Secretory phospholipase A2 in SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C).

Secretory phospholipase 2 (sPLA2) acts as a mediator between proximal and distal events of the inflammatory cascade. Its role in SARS-CoV-2 infection is unknown, but could contribute to COVID-19 inflammasome activation and cellular damage. We present the first report of plasma sPLA2 levels in adults and children with COVID-19 compared with controls. Currently asymptomatic adults with a history of recent COVID-19 infection (≥4 weeks before) identified by SARS-CoV-2 IgG antibodies had sPLA2 levels similar to those who were seronegative (9 ± 6 vs.17 ± 28 ng/mL, P = 0.26). In contrast, children hospitalized with severe COVID-19 had significantly elevated sPLA2 compared with those with mild or asymptomatic SARS-CoV-2 infection (269 ± 137 vs. 2 ± 3 ng/mL, P = 0.01). Among children hospitalized with multisystem inflammatory syndrome in children (MIS-C), all had severe disease requiring pediatric intensive care unit (PICU) admission. sPLA2 levels were significantly higher in those with acute illness <10 days versus convalescent disease ≥10 days (540 ± 510 vs. 2 ± 1, P = 0.04). Thus, sPLA2 levels correlated with COVID-19 severity and acute MIS-C in children, implicating a role in inflammasome activation and disease pathogenesis. sPLA2 may be a useful biomarker to stratify risk and guide patient management for children with acute COVID-19 and MIS-C. Therapeutic compounds targeting sPLA2 and inflammasome activation warrant consideration.

Compassionate Use of Remdesivir in Children With Severe COVID-19.

OBJECTIVES: Remdesivir shortens time to recovery in adults with severe coronavirus disease 2019 (COVID-19), but its efficacy and safety in children are unknown. We describe outcomes in children with severe COVID-19 treated with remdesivir. METHODS: Seventy-seven hospitalized patients <18 years old with confirmed severe acute respiratory syndrome coronavirus 2 infection received remdesivir through a compassionate-use program between March 21 and April 22, 2020. The intended remdesivir treatment course was 10 days (200 mg on day 1 and 100 mg daily subsequently for children ≥40 kg and 5 mg/kg on day 1 and 2.5 mg/kg daily subsequently for children <40 kg, given intravenously). Clinical data through 28 days of follow-up were collected. RESULTS: Median age was 14 years (interquartile range 7-16, range <2 months to 17 years). Seventy-nine percent of patients had ≥1 comorbid condition. At baseline, 90% of children required supplemental oxygen and 51% required invasive ventilation. By day 28 of follow-up, 88% of patients had a decreased oxygen-support requirement, 83% recovered, and 73% were discharged. Among children requiring invasive ventilation at baseline, 90% were extubated, 80% recovered, and 67% were discharged. There were 4 deaths, of which 3 were attributed to COVID-19. Remdesivir was well tolerated, with a low incidence of serious adverse events (16%). Most adverse events were related to COVID-19 or comorbid conditions. Laboratory abnormalities, including elevations in transaminase levels, were common; 61% were grades 1 or 2. CONCLUSIONS: Among 77 children treated with remdesivir for severe COVID-19, most recovered and the rate of serious adverse events was low.

Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers.

OBJECTIVES: To determine SARS-CoV-2-antibody prevalence in pediatric healthcare workers (pHCWs). DESIGN: Baseline prevalence of anti-SARS-CoV-2-IgG was assessed in a prospective cohort study from a large pediatric healthcare facility. Prior SARS-CoV-2 testing history, potential risk factors and anxiety level about COVID-19 were determined. Prevalence difference between emergency department (ED)-based and non-ED-pHCWs was modeled controlling for those covariates. Chi-square test-for-trend was used to examine prevalence by month of enrollment. RESULTS: Most of 642 pHCWs enrolled were 31-40years, female and had no comorbidities. Half had children in their home, 49% had traveled, 42% reported an illness since January, 31% had a known COVID-19 exposure, and 8% had SARS-CoV-2 PCR testing. High COVID-19 pandemic anxiety was reported by 71%. Anti-SARS-CoV-2-IgG prevalence was 4.1%; 8.4% among ED versus 2.0% among non-ED pHCWs (p < 0.001). ED-work location and known COVID-19 exposure were independent risk factors. 31% of antibody-positive pHCWs reported no symptoms. Prevalence significantly (p < 0.001) increased from 3.0% in April-June to 12.7% in July-August. CONCLUSIONS: Anti-SARS-CoV-2-IgG prevalence was low in pHCWs but increased rapidly over time. Both working in the ED and exposure to a COVID-19-positive contact were associated with antibody-seropositivity. Ongoing universal PPE utilization is essential. These data may guide vaccination policies to protect front-line workers.

Burden of Illness in Households With Severe Acute Respiratory Syndrome Coronavirus 2-Infected Children.

We investigated of illness among household members of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children receiving medical care (n = 32). We identified 144 household contacts (HCs): 58 children and 86 adults. Forty-six percent of HCs developed symptoms consistent with coronavirus disease. Child-to-adult transmission was suspected in 7 cases.