EVALUATING THE ETHICAL AND SOCIETAL IMPACTS OF MODELLING PANDEMIC CRISES: EXPERIENCES FROM A WORKSHOP

This paper describes a hybrid (virtual and online) workshop held as part of the EU STAMINA project that aimed to engage project partners to explore ethics and simulation modelling in the context of pandemic preparedness and response. The purpose of the workshop was to consider how the model's design and use in specific pandemic decision-making contexts could have broader implications for issues like transparency, explainability, representativeness, bias, trust, equality, and social injustices. Its outputs will be used as evidence to produce a series of measures that could help mitigate ethical harms and support the greater possible benefit from the use of the models. These include recommendations for policy, data-gathering, training, potential protocols to support end-user engagement, as well as guidelines for designing and using simulation models for pandemic decision-making. This paper presents the methodological approaches taken when designing the workshop, practical concerns raised, initial insights gained, and considers future steps. © SW 2023.All rights reserved

BURDEN AND SEVERITY OF COVID-19 IN CHILDREN HOSPITALISED OVER FIVE COVID-19 WAVES IN SOWETO, SOUTH AFRICA

Intro There is sparse data on SARS-CoV-2 infection among paediatric patients from low-middle income countries (LMICs), including from sub-Saharan Africa. We describe the burden and severity of disease in children treated with SARS- CoV-2 infection at an academic hospital in Soweto, South Africa from 30 March 2020 through 30 June 2022. Methods SARS-CoV-2 was detected using reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal swab specimens. Clinical diagnoses, HIV status, admission C-reactive protein (CRP), blood culture results and clinical outcomes were captured. Epidemic waves were designated as follows: Wave 1 (01 March to 14 October 2020);Wave 2 (15 October 2020 to 17 May 2021);Wave 3 (18 May to 14 November 2021);Wave 4 (15 November 2021 to 14 March 2022);Wave 5 (15 March to 30 June 2022). Findings There were 797 SARS-CoV-2 positive paediatric hospitalisations in the study period. SARS-CoV-2 detection prevalence was 4.6% (77/1,673) in Wave 1, 3.9% (134/3,426) in Wave 2, 7.1% (187/2,618) in Wave 3, 12.5% (261/2,088) in Wave 4 and 5.9% (138/2,320) in Wave 5. Among SARS-CoV-2 positive cases, the prevalence of respiratory admission diagnoses increased over time (16.9% in Wave 1 to 42.8% in Wave 5). Conversely, the prevalence of multisystem inflammatory syndrom of childhood (MIS-C) and case fatailty ratios (CFRs) declined from Wave 1 to Wave 5 (MIS-C: 20.8% to 2.2%;CFR: 9.1% to 3.6%). Death was significantly associated with younger age (median age 3.4 versus 16.9 months), positive admission blood cultures (24.0% versus 8.4%), MIS-C (20.7% versus 6.5%), and HIV infection (21.1% versus 4.5%). Conclusion The omicron dominated fourth and fifth waves of SARS-CoV-2 infection were associated with a higher prevalence of respiratory admission diagnoses, but lower case fatality compared to the ancestral first wave in South African children. Optimisation of antenatal maternal SARS-CoV-2 vaccination and early HIV diagnosis may impact on paediatric SARS-CoV-2 CFR.

Occupational risk of COVID-19 in foreign-born employees in Denmark.

BACKGROUND: Foreign-born workers in high-income countries experience higher rates of COVID-19 but the causes are only partially known. AIMS: To examine if the occupational risk of COVID-19 in foreign-born workers deviates from the risk in native-born employees in Denmark. METHODS: Within a registry-based cohort of all residents employed in Denmark (n = 2 451 542), we identified four-digit DISCO-08 occupations associated with an increased incidence of COVID-19-related hospital admission during 2020-21 (at-risk occupations). The sex-specific prevalence of at-risk employment in foreign born was compared with the prevalence in native born. Moreover, we examined if the country of birth modified the risk of a positive SARS-CoV-2 polymerase chain reaction (PCR) test and COVID-19-related hospital admission in at-risk occupations. RESULTS: Workers born in low-income countries and male workers from Eastern Europe more often worked in at-risk occupations (relative risks between 1.16 [95% confidence interval {CI} 1.14-1.17] and 1.87 [95% CI 1.82-1.90]). Being foreign-born modified the adjusted risk of PCR test positivity (test for interaction P < 0.0001), primarily because of higher risk in at-risk occupations among men born in Eastern European countries (incidence rate ratio [IRR] 2.39 [95% CI 2.09-2.72] versus IRR 1.19 [95% CI 1.14-1.23] in native-born men). For COVID-19-related hospital admission, no overall interaction was seen, and in women, country of birth did not consistently modify the occupational risk. CONCLUSIONS: Workplace viral transmission may contribute to an excess risk of COVID-19 in male workers born in Eastern Europe, but most foreign-born employees in at-risk occupations seem not to be at higher occupational risk than native born.

Frequent reversible causes to deteriorised or lost olfactory or gustatory function

Change in olfactory and/or gustatory dysfunction have gained attention in recent years because of COVID-19. However, these symptoms are common and have numerous different aetiologies, which should not be forgotten. Adequate diagnostic work up and clinical examination is essential. Treatment may include olfactory training, topically applied steroids and perhaps surgery. This review summarises common reversible causes of olfactory and/or gustatory dysfunction and current treatment modalities.

Frequent reversible causes to deteriorised or lost olfactory or gustatory function.

Change in olfactory and/or gustatory dysfunction have gained attention in recent years because of COVID-19. However, these symptoms are common and have numerous different aetiologies, which should not be forgotten. Adequate diagnostic work up and clinical examination is essential. Treatment may include olfactory training, topically applied steroids and perhaps surgery. This review summarises common reversible causes of olfactory and/or gustatory dysfunction and current treatment modalities.

Sink or swim: Exploring resilience of academics at an education Covid-19

There is a proliferation of local and international research focusing on Covid-19 and its impact on teaching and learning practices in higher education. However, there is considerably less focus on the resilience of academics in higher education during the pandemic in South Africa. To consider this gap, a group of curriculum officers at an education faculty based at a university of technology in the Western Cape set out to explore how resilient academics were during Covid-19. Thirteen academics who teach in and across the Foundation, Intermediate, and Further Education and Training phases participated in a focus group interview. Data was analysed thematically using content analysis and three themes were identified: creativity through complexity;embracing challenge through resilience;and connecting with self. The implications reveal that universities as a contextual environment for promoting resilience need to engage with the social and physical ecology of staff by providing support and resources to facilitate resilience during times of crisis. The dominant nature of the hierarchical dynamics of the university's management also needs to be considered as part of a social-ecological perspective in valuing academics' wellbeing during emergencies.

Pandemic Detours or New Sustainable Pathways? Post-pandemic Mobility Futures in Danish Cities

When mobility normality breaks down, new futures can emerge. This paper explores COVID-19 disruptions of everyday mobility in Danish cities and new emerging pathways toward less carbon-intensive mobility futures in the light of the mobile risk society and practice theory. It uses a stakeholder workshop with public transport providers as empirical outset to start conceptualizing new discussions that have emerged in the wake of COVID-19. Through four inquiries into pandemic-induced changes–including reducing, remoding, rescheduling and replacing mobility practices–it discusses how a new critical view on “business as usual” has emerged from the pandemic, especially in relation to public transport and linkage to other transport modes. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Redesigning global supply chains during compounding geopolitical disruptions: the role of supply chain logics

Purpose Why do managers redesign global supply chains in a particular manner when faced with compounding geopolitical disruptions? In answering this research question, this study identifies a constrained system of reasoning (decision-making logic) employed by managers when they redesign their supply chains in situations of heightened uncertainty. Design/methodology/approach The authors conducted 40 elite interviews with senior supply chain executives in 28 companies across nine industries from November 2019 to June 2020, when the UK was preparing to leave the European Union, the US-China trade war was escalating, and Covid-19 was spreading rapidly around the globe. Findings When redesigning global supply chains, the authors find that managerial decision-making logic is constrained by three distinct environmental ecosystem conditions: (1) the perceived intensity of institutional pressures;(2) the relative mobility of suppliers and supply chain assets;and (3) the perceived severity of the potential disruption risk. Intense government pressure and persistent geopolitical risk tend to impact firms in the same industry, resulting in similar approaches to decision-making regarding supply chain design. However, where suppliers are relatively immobile and supply chain assets are relatively fixed, a dominant logic is consistently present. Originality/value Building on an institutional logics perspective, this study finds that managerial decision-making under heightened uncertainty is not solely guided by institutional pressures but also by perceptions of the severity of risk related to potential supply chain disruption and the immobility of supply chain assets. These findings support the theoretical development of a novel construct that the authors term 'supply chain logics'. Finally, this study provides a decision-making framework for Senior Executives competing in an increasingly complex and unstable business environment.

Pre-treatment pain sensitivity is associated with outcome following exercise therapy in patients with knee osteoarthritis - an observational study

Purpose: Exercise therapy in combination with education is recommended as first-line treatment for painful knee osteoarthritis (KOA). In clinical practice, supervised exercise therapy and education demonstrate approx. 25% pain relief following an 8-week treatment program. Studies indicate that some patients with KOA experience larger pain relief compared to others. Assessments of peripheral and central pain mechanisms has been used to predict responders and non-responders to treatment. Studies on surgery and treatment with non-steroid anti-inflammatory drugs in patients with KOA have indicated that patients with higher levels of pain sensitivity might respond less positive. The primary aim of this observational study was to investigative if measures of pre-treatment pain sensitivity was associated with clinical outcomes after supervised exercise therapy and education. Methods: Patients with painful KOA (numeric rating scale [NRS, 0-10] ≥ 3) were included, and examined before and 1-2 weeks after 6-8 weeks of supervised exercise therapy (2 sessions of 1 hour per week) and 2 sessions of patient education. Handheld pressure pain threshold (PPT) was assessed locally at the most painful knee at 4 peripatellar sites (knee) and at two remote sites at the m. tibialis anterior (TA) and the contralateral m. extensor carpi radialis longus (ECRL). Further, computer-controlled cuff algometry at the lower leg with the most intense knee pain was used to assess pain detection threshold (cPDT), pain tolerance threshold (cPTT) and conditioned pain modulation (cCPM). Peak pain intensity within the last 24 hours (NRS, 0-10), PainDetect questionnaire (PDQ, 0-38) and Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed as clinical measures. PDQ assesses the pain phenotype with a score ≤ 12 indicating probably nociceptive pain, 13-18 uncertain pain phenotype and ≥ 19 probably neuropathic pain. KOOS4 was defined as the average score of the subscale scores for Pain, Symptoms, Activity of Daily Living and Quality of Life (0-100 with 0 indicating extreme problems and 100 indicating no problems). Physical performance was assessed using the 40-meter walk test (40MWT). A treatment attendance score (%) was calculated for each patient by dividing the number of sessions attended by the number of sessions scheduled (twice per week). This study was approved by the local ethical committee (N-20190045) and pre-registered at (NCT04123756). All participants gave oral and written informed consent prior to enrollment. Results: This interim analysis reports on the first patients recruited for this observational study. Eleven KOA patients (6 women) with mean peak pain intensity of 6.0 ± 1.5, median pain duration 17.0 months (range: 5-120) and body mass index of 30.3 ± 5.7 were included in this interim analysis. In one subject, follow-up was made by telephone due to the COVID-19 situation, leaving 10 subject for the analysis on changes in pain sensitivity measures. Attendance score was 98.1 ± 18.1% during 7.1 ± 0.7 weeks. Following treatment, improvements were observed in KOOS4 (57.1 ± 10.0 at baseline vs. 65.3 ± 13.1 at follow-up, P < 0.01), and peak pain intensity (6.0 ± 1.5 vs. 3.2 ± 2.3, P < 0.001). No differences were seen for PDQ (7.6 ± 2.6 vs 6.8 ± 3.6, P = 0.77) and 40MWT (27.1 ± 6.6 sec vs. 25.8 ± 5.2 sec, P = 0.29). Further, no changes in any of the pain sensitivity measures were found following treatment (all Ps > 0.15). Pre-treatment cPDT (rs < 0.73, P < 0.05) and cPTT (rs < 0.72, P < 0.05) were associated with post-treatment KOOS4. No significant associations were found between pre-treatment PPT or CPM effects and post-treatment peak pain measures or change in KOOS-4 (P > 0.05). Conclusions: These results indicate that patients with higher pre-treatment pressure pain sensitivity have worse KOOS4 scores following supervised exercise therapy and education.

Pandemic paradox: Patterns of traumatic injuries during COVID-19 despite the safe haven of home

INTRODUCTION: The novel coronavirus outbreak has resulted in a stay at home mandates to prevent community transmission of the disease. As the pandemic has intensified, further mandates escalated isolated environments such as school and business closures, travel restrictions, and social distancing. As citizens were forced to stay home, the crisis created unique trends in traumatic injuries. METHODS: A retrospective review of all trauma registry patients presenting to a rural American College of Surgeons (ACS) verified level one trauma center with associated trauma activation before and during the Coronavirus 2019 (COVID-19) pandemic, integral dates January 1, 2020, to May 1, 2020. A comparison was made regarding trauma trends based on the previous year (January 1, 2019, to May 1, 2019). The data collected included patient characteristics, grouping by trauma activation, injury type, injury severity score (ISS), alcohol screen, drug screen, and mode of injury. RESULTS: A statistically significant increase was found largely among males (P = 0.02) with positive alcohol screens (P < 0.001). The statistically significant mode of injury among this trauma population included falling, jumping, pushed (P = 0.02);self-harm-jump (P = 0.01);assault (P = 0.03);and assault with sharp object (P = 0.036). CONCLUSIONS: Before and during the COVID-19 stay at home mandates, overall trauma volume was reduced. Significant increases in specific trauma trends were observed, including falls, jumps, and pushed;self-harmjumps;assaults;and assaults with sharp objects. Marked increases in trauma trends were seen among men with higher alcohol levels than those preceding the pandemic.

The fallacy of safety during quarantine: Increased domestic violence during the COVID-19 pandemic

INTRODUCTION: As the early peak phase of the novel coronavirus outbreak has intensified, individuals identified as nonessential were advised to remain home to prevent community transmission of the disease. The stay at home mandates further escalated isolated environments such as school closures, social distancing, travel restrictions, closure of public gathering spaces, and business closures. As citizens were forced to stay home during the pandemic, the crisis created intensifying stressors and isolation, which fostered an environment for increased domestic violence. METHODS: A retrospective review of all emergency department (ED) patients that presented to an American College of Surgeons (ACS) verified rural level one trauma center with associated diagnostic coding for assault was conducted during the Coronavirus 2019 (COVID-19) lockdown, integral dates March 16, 2020, to April 30, 2020. In particular, the identification of proportional assaults presented to the ED after school closures (March 16, 2020) was compared to the previous year (March 16, 2019, to April 30, 2019). The data collected included patient characteristics, grouping by mechanism, grouping by a specific mechanism, and domestic violence perpetrators. RESULTS: A statistically significant (p = 0.01) increase in assaults was found during the COVID-19 lockdown, particularly during school closures. CONCLUSIONS: Despite overall reductions in trauma volume during the COVID-19 stay at home mandates, a significant increase in domestic violence assaults was observed. The assaults were perpetrated mainly against white men by partners and unspecified non-family members, which were predominantly penetrating injuries.

Partnership between a large academic medical center and blood supplier to maintain the blood supply during the initial COVID-19 outbreak in the United States

Background/Case Studies: Due to physical distancing measures implemented in March 2020 to mitigate the spread of the COVID-19, over 4,000 community blooddrives were cancelled resulting in more than 100,000 fewer blood units collected in the US during the initial outbreak (1). Here we describe a successful partnership between a large academic medical center and a major blood provider to help prevent a critical blood shortage in our community. Study Design/Methods: Vanderbilt University Medical Center (VUMC), a large academic medical center including the only level I trauma center in metropolitan Nashville, Tennessee, partnered with the American Red Cross (ARC) to increase the number of blood drives on-campus with hospital leadership support to overcome administrative and logistical barriers quickly with increased media communications to faculty and staff through the hospital media team. Prior to the COVID-19 pandemic, oncampus blood drives averaged twice per month, but in March of 2020, our teams were able to increase oncampus blood drives to 2 to 3 times weekly safely and in compliance with guidelines recommended by the Centers for Disease Control and Prevention (CDC). The number of whole blood units collected during comparable months in 2018, 2019 and 2020 were compared. Results/Findings: From March through July of 2018, ten blood drives were held yielding a total of 212 units of whole blood. From March through July of 2019, ten blood drives were held yielding a total of 249 units of whole blood. From March through July 12 of 2020, 41 blood drives were held yielding a total of 1,167 units of whole blood (see Table 1). Whole blood units collected from March 1 to July 12, 2020 increased 550% compared with March to July 2018 on-campus. Conclusions: During the initial COVID-19 pandemic outbreak in the United States, the blood supply was severely threatened due to mass cancellations of donor blood drives. We demonstrated a very successful partnership between a large academic medical center and a major blood provider to substantially increase the frequency of on-campus blood drives which resulted in a significant increase in the number of whole blood units collected compared with prior years. Hospital leadership and media team support to overcome many logistical and administrative barriers was key to quickly implementing blood drives on-campus and increasing donor turnout.