Orphanhood and caregiver death among children in the United States due to all-cause mortality 2000-2021: A Modeling Study (preprint)

Importance: Deaths of parents and grandparent caregivers linked to social and health crises threaten child wellbeing due to losses of nurturance, financial support, physical safety, family stability, and care. Little is known about the full burden of all-causes and leading cause-specific orphanhood and caregiver death beyond estimates from select causes. Objective: To estimate 2000-2021 prevalence and incidence trends of all-cause orphanhood and caregiver death among children <18, by cause, age, race/ethnicity, and state. Data Sources: National Center for Health Statistics (NCHS) birth, death, race/ethnicity, and population data to estimate fertility rates and identify causes of death; 1983-1998 ICD-9 causes-of-death harmonized to ICD-10 classifications; 1999-2021 ICD-10 causes-of-death; CDC WONDER for state-specific estimates; and American Community Survey for grandparent population estimates. Data extraction and synthesis: We extracted U.S. population-level death, birth, population size, race, and ethnicity data from NCHS and attributed to each deceased individual the average number of children left behind according to subgroup-specific fertility rates in the previous 0-17 years. We examined prevalence and incidence of orphanhood by leading causes-of-death, including COVID-19, the leading 5 causes-of-death for 1983-2021, and additional leading causes for ages 15-44. We extended these to obtain state-level outcome estimates. Main outcome measures: National incidence and prevalence of orphanhood and caregiver death from 2000-2021, with orphanhood by year, parental cause-of-death and sex, child age, race/ethnicity, and state. Results: From 2000-2021, orphanhood and custodial/co-residing grandparent caregiver loss annual incidence and prevalence trends increased 49.2% and 8.3%, respectively. By 2021, 2.9 million children (4% of all children) had experienced prevalent orphanhood and caregiver death. Populations disproportionately affected by orphanhood included 5.0% of all adolescents; 6.5%, 4.8%, and 3.9% respectively of non-Hispanic American Indian/Alaska Native, non-Hispanic Black, and non-Hispanic White children; and children in New Mexico and Southern and Eastern States. Parental death due to drug overdose during 2020-2021 surpassed COVID-19 as the leading cause of incident and prevalent orphanhood during the COVID-19 pandemic. Conclusions and Relevance: Policies, programs, and practices aimed at orphanhood prevention, identification, and linkage to services and support of nearly 3 million bereaved children are needed, foremost prioritizing rapidly increasing overdose-linked orphanhood.

Coordinating risk communication and community engagement for a better COVID-19 response in Eastern and Southern Africa.

Risk Communication and Community Engagement (RCCE) is crucial for effective public health emergency response, with coordination of RCCE essential to avoiding duplication, resource wastage and possible confusion at community level. We describe the structure and operational modalities of the regional RCCE coordination mechanism for COVID-19 in Eastern and Southern Africa since the declaration of the first cases in countries in the region in March 2020. Under the co-leadership of UNICEF and the International Federation of Red Cross and Red Crescent Societies (IFRC), more than 30 agencies including UN agencies, Non-Government organisations, media and interfaith councils shared information on their interventions and support to the regional COVID-19 response. The technical working group has facilitated the development of joint guidance and reports. The group also shared monthly community feedback reports, Fact sheets, Theme specific Guidance Notes, media webinars and Social science evidence reviews from the sub-working groups. The Bill and Melinda Gates Foundation provided complementary resources to strengthen the regional coordination and tailored support to country RCCE response processes. This manuscript documents a regional approach to RCCE coordination for public health emergency response for potential replication and knowledge to inform and guide future RCCE for preparedness and response at regional level.

Coordinating risk communication and community engagement for a better COVID-19 response in Eastern and Southern Africa

Risk Communication and Community Engagement (RCCE) is crucial for effective public health emergency response, with coordination of RCCE essential to avoiding duplication, resource wastage and possible confusion at community level. We describe the structure and operational modalities of the regional RCCE coordination mechanism for COVID-19 in Eastern and Southern Africa since the declaration of the first cases in countries in the region in March 2020. Under the co-leadership of UNICEF and the International Federation of Red Cross and Red Crescent Societies (IFRC), more than 30 agencies including UN agencies, Non-Government organisations, media and interfaith councils shared information on their interventions and support to the regional COVID-19 response. The technical working group has facilitated the development of joint guidance and reports. The group also shared monthly community feedback reports, Fact sheets, Theme specific Guidance Notes, media webinars and Social science evidence reviews from the sub-working groups. The Bill and Melinda Gates Foundation provided complementary resources to strengthen the regional coordination and tailored support to country RCCE response processes. This manuscript documents a regional approach to RCCE coordination for public health emergency response for potential replication and knowledge to inform and guide future RCCE for preparedness and response at regional level.

EMERGENCY MEDICINE PHYSICIANS IN THE ICU DURING THE 2020 WINTER COVID-19 SURGE

B Introduction: b Emergency Medicine (EM) physicians have a skill set complementary to intensivists with a larger overall workforce. Intubations in the ICU were routinely performed by the EM-ICU freeing up anesthesia personnel. B Discussion: b The addition of an EM-ICU attending to an intensivist-led ICU team increased the efficiency of care delivery in our MICU during the winter 2020 COVID-19 surge. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A Practical Approach for Geographic Prioritization and Targeting of Insecticide-Treated Net Distribution Campaigns During a Public Health Emergency (preprint)

BackgroundThe use of data in targeting of malaria control efforts is becoming increasingly adopted by national malaria control programmes and is essential for optimal use of resources. This is especially important during public health emergencies such as the COVID-19 pandemic which resulted in reallocation of funding towards containment efforts. This work provides a practical mechanism for prioritizing geographical areas for insecticide-treated net (ITN) distribution during a public health emergency or situations of limited resources. We adopt a GIS-based weighted approach to categorize and rank administrative units based on data inputs that are widely available and can be applied in various country contexts where Plasmodium falciparum transmission is reported. MethodsP. falciparum-specific intervention and prevailing risk factors were used to rank administrative units in Nigeria for prioritization during ITN distributions. Each factor was assigned a unique weight and was multiplied by a value, typically ranging from 1 to 4, based on natural groupings inherent in the data, or the presence or absence of a given intervention. Risk scores for each factor were then summated to generate a composite unique risk score for each administrative unit. This risk score was then translated into a prioritization map which ranks each administrative unit from low to high priority in terms of ITN distribution targeting in situations of limited resources. ResultsA major component that influenced the prioritization scheme was previous ITN depth of coverage, as obtained and spatially interpolated from DHS survey data. The geospatial heterogeneity found among input risk factors suggests that a range of variables and covariates — outside of those that characterize malaria transmission exclusively — should be considered when using data to inform ITN distributions. The approach resulted in identification of regions that should be prioritized in upcoming ITN distributions. ConclusionThe presented approach provides a tool for prioritizing regions for ITN distributions. It serves as a base upon which a wider range of vector control interventions could be targeted. Its value added can be found in its potential for application in multiple country contexts, expediated timeframe for producing outputs, and its use of systematically collected malaria indicators in informing prioritization.

Under the Radar: Global Minimum Estimates for COVID-19-Associated Orphanhood and Deaths Among Caregivers During 2020 (preprint)

Background: The global COVID-19 pandemic and response has focused on prevention, detection, and response. Beyond morbidity and mortality of those infected, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, delayed development, and institutionalization. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation.Methods: We use mortality and fertility data to model rates of COVID-19-associated orphanhood and caregiver deaths for 18 countries in Africa, Asia, Europe, and the Americas, and extrapolate global estimates of COVID-associated deaths of parents and grandparent caregivers.Results: We estimate that globally, >1 million children were orphaned or lost a caregiver due to COVID-19-associated deaths during March–December 2020. Countries with higher rates of caregiver deaths included Peru, South Africa, Mexico, Russian Federation, Colombia, Brazil, Islamic Republic of Iran, Argentina, U.S.A., and Spain (range, 1·1–9·8/1000). For most countries, numbers of children orphaned were greater than deaths among those aged 15–44 years; 2–5 times more children had deceased fathers than deceased mothers.Conclusions: Orphanhood and caregiver deaths are a shadow pandemic resulting from COVID-19-associated deaths: we find that over one million children worldwide have lost a parent or caregiver in just ten months. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families nurture children bereft of caregivers and promote their recovery. Strengthening family-based care can help ensure that institutionalization of these children is avoided. These data demonstrate the need for an additional pillar of our response: prevent, detect, respond, and care for children.Funding: UK Research and Innovation (Global Challenges Research Fund (GCR), Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, U.S. National Institutes of Health, Imperial College.Declaration of Interests: Dr. Donnelly reports grants from UK Medical Research Council and grants from NIHR during the conduct of the study. Dr. Cluver reports grants from UK Research and Innovation (UKRI) Global Challenges Research Fund, during the conduct of the study. All other authors report nothing to disclose.Ethics: We used modeled aggregate data and publicly available de-identified survey metadata.

Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease.

BACKGROUND: Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited. METHODS: We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS). RESULTS: We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS: 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization. CONCLUSIONS: In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.

Risks Of Ventilator-Associated Pneumonia And Invasive Pulmonary Aspergillosis In Patients With Viral Acute Respiratory Distress Syndrome Related or Not To Coronavirus 19 Disease (preprint)

Background: The goal of this study was to assess risk factors of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with SARS-CoV-2 infection. Methods: . We conducted a monocenter retrospective study comparing the prevalence of VAP and invasive aspergillosis between patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS). Results: . We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 hours. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p<0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS : 58 (64%) vs. 36 (44%), p=0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p<0.01].The prevalence of multi-drug resistant bacteria (MDR) related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p=0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p<0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p=0.003], but there was no difference in Aspergillus colonization. Conclusions: . In this retrospective case-control study, we evidenced a higher prevalence of VAP and MDR-VAP in C-ARDS than in NC-ARDS, and a lower risk for invasive aspergillosis in the former group.