Impact of COVID-19 on medical school admissions at The University of Arizona College of Medicine – Tucson (preprint)

Background: The COVID-19 pandemic presented unforeseen obstacles to prospective medical students such as Medical College of Admission Test (MCAT) scheduling postponements and technical challenges during virtual interviews. Students were also faced with difficult decisions post-submission such as having to choose a program without ever visiting a school in-person. Objective: The primary objective of the present study was to assess the effect of the COVID-19 pandemic on medical school admission preferences and application-related costs. This may also provide feedback to medical school administrators for future improvements to the application process. Methods: A retrospective survey of the class of 2024 (Co24; non-COVID-19 cohort) and class of 2025 (Co25; COVID-19 cohort) was conducted in the Fall of 2021 via the Qualtrics online survey software. Statistical analysis incorporated the chi-square test on the Likert scale. Results: There were 195 survey respondents: 77 students from the Co2024 and 89 students from the Co25. More students in the Co25 had to reschedule their MCAT compared to the Co24 (56.1% versus 14.3%; p <0.001). The in-person Co24 had higher travel-related expenses (>$500) compared to the Co25 who interviewed virtually (65.1% versus 2.4%; p <0.001). More students from the Co24 preferred the in-person interview format compared to the Co25 (85.7% versus 22.5%; p <0.001). Lastly, 87% of the Co24 and 24.7% of the Co25 felt they were able to gather a clear impression of the atmosphere and culture of a school from the interview trail alone (p <0.001). Conclusion: Matriculated medical students at an allopathic medical school who applied during the COVID-19 pandemic had more pre-application hurdles when compared to prior cohorts. Students in the COVID-19 cohort, who primarily had virtual interviews, had less travel-related costs but felt more limited in their experience of a school’s culture. Despite this, however, the COVID-19 cohort still expressed a preference for virtual interviews.

SARS-CoV-2 mRNA vaccination exposes progressive adaptive immune dysfunction in patients with chronic lymphocytic leukemia (preprint)

Chronic lymphocytic leukemia (CLL) patients have lower seroconversion rates and antibody titers following SARS-CoV-2 vaccination, but the reasons for this diminished response are poorly understood. Here, we studied humoral and cellular responses in 95 CLL patients and 30 healthy controls after two BNT162b2 or mRNA-2173 mRNA immunizations. We found that 42% of CLL vaccinees developed SARS-CoV-2-specific binding and neutralizing antibodies (NAbs), while 32% had no response. Interestingly, 26% were seropositive, but had no detectable NAbs, suggesting the maintenance of pre-existing endemic human coronavirus-specific antibodies that cross-react with the S2 domain of the SARS-CoV-2 spike. These individuals had more advanced disease. In treatment-naïve CLL patients, mRNA-2173 induced 12-fold higher NAb titers and 1.7-fold higher response rates than BNT162b2. These data reveal a graded loss of immune function, with pre-existing memory being preserved longer than the capacity to respond to new antigens, and identify mRNA-2173 as a superior vaccine for CLL patients.

Current status and influential factors for family health management during quarantine: A latent category analysis.

OBJECTIVE: We aimed to explore factors affecting family health management during home quarantine as well as the effects of variations in family health management (FHM) on individuals' health status. METHODS: Using stratified random sampling, 618 families in Wuhan as well as cities within its surrounding provinces were recruited and surveyed online. Latent class variables were extracted from four modules: disinfection, space layout, physical exercise, and food reserves. The analysis was conducted using the poLCA package in R software (v.4.1.0). Chi-squared tests, Fisher's exact tests, and non-parametric Kruskal-Wallis tests were used to compare groups as appropriate. RESULTS: We found an overall questionnaire reliability of 0.77 and a total omega of 0.92, indicating that the survey results were credible. The Bayesian information criterion and Akaike information criterion were used to identified four latent class variables, namely latent non-family health management (18.9%) and latent low, medium, and advanced FHM (30.93%, 29.49%, and 20.59%, respectively). Gender, household income level, body mass index, the presence of a nearby community hospital, and self-rated health status showed statistically significant differences with respect to latent FHM. Moreover, we found a statistically significant difference in emotional reactions when comparing latent advanced and low to mid-level latent FHM. Compared with latent non-family health managers, we detected statistically significant differences in individual energy levels between potential family health managers at latent low and medium levels. Additionally, we found statistically significant differences in individual energy levels between latent advanced and low level family health managers. CONCLUSIONS: We found that multiple factors, including gender, household income, and body mass index, were correlated with latent FHM during home quarantine. We conclude that FHM can meaningfully improve individuals' health. Thus, increasing social support for individuals can improve FHM as well as individuals' health during home quarantine.

Precise Community-Based Public Health Management: Crucial Experience Responding to COVID-19 in Wuhan, China.

INTRODUCTION: Facing a grim public challenge caused by COVID-19, many countries decide to live with it for a long time, whereas China continues to enforce precise community-based public health management. This paper summarized China's approaches and aimed to provide illumination for health services decision-makers. METHODS: We systematically reviewed the construction of precise community-based public health management from three aspects: organizational structure, service content, and flexible adjustment, and summed up four essential elements for success. Then, we selected 9 typical countries to compare their non-pharmaceutical strategies and daily new cases. RESULTS: China's community-based public health management has a clear four-level organizational structure. It has worked on infection control, surveillance for new cases, management of contacts, health education, medicare service, outdoor environment disinfection, and living material supply in different stages, and the daily new confirmed cases in Wuhan sustainedly declined to zero. The outbreak was relatively well contained in China, Italy, and Germany as of June 2020, as they adopted stricter movement restrictions, social distance, and patient tracking. CONCLUSION: China's experience has proved the feasibility of non-pharmaceutical strategies responding to COVID-19. The precise community-based public health management strategy can be considered, as it's pretty much the same as public health and social measures (PHSMs) advocated by WHO.

Hand hygiene, mask-wearing behaviors and its associated factors during the COVID-19 epidemic: a cross-sectional study among primary school students in Wuhan, China

Although the emphasis on behaviors of hand-washing and mask-wearing was repeated during the pandemic of Coronavirus Disease 2019 (COVID-19), not everyone paid enough attention to this. A descriptive statistic was used to make sense of the status of hand hygiene and mask-wearing among primary school students in Wuhan, China. A binary logistic regression analysis was conducted to identify the risk factors affecting the behaviors of hand-washing and mask-wearing. p < 0.05 (two-sides) was considered as significant at statistics. 42.05% of the primary school students showed a good behavior of hand-washing, while 51.60% had a good behavior of mask-wearing. Gender, grade, out-going history, father's occupation, mother's educational background, and the time filling out the survey were significantly associated with hand hygiene, whereas grade, mother's educational background, and residence were associated with mask-wearing. The behaviors of hand-washing and mask-wearing among primary school students were influenced by gender, grade, and other factors, therefore, parents should make efforts of behavior guidance whereas governments should enlarge medium publicity.

Associations between Indoor Environmental Quality and Infectious Diseases Knowledge, Beliefs and Practices of Hotel Workers in Wuhan, China.

Knowledge, beliefs, and practices regarding infectious diseases are key elements that ensure practitioners' health and safety. It is important to carry out such a survey in hotels. This study aims to determine the levels of knowledge, beliefs, and practices regarding infectious diseases among practitioners and their associations with the environmental quality of hotels in Wuhan, China. We surveyed infectious disease knowledge, beliefs, and practices of practitioners in 18 hotels and detected these hotels' environment, including physical factors of temperature, humidity, noise, and the indoor air quality of benzene, toluene, xylene, formaldehyde, CO, CO2, the total count of fungi, aerobic plate count, PM10, and PM2.5. 128 practitioners were included, and 28.9% were male. The questionnaire included knowledge, beliefs, and practices regarding infectious diseases. Our study found moderate levels of knowledge and beliefs, and good health practices. People's beliefs toward COVID-19 were correlated significantly with their knowledge (p < 0.05). Beliefs and health practices were correlated significantly with environmental quality (p < 0.05). However, the environmental quality was correlated negatively with the classification of hotels. Conclusively, despite the good health practices of practitioners, the knowledge and beliefs toward infectious diseases need to strengthen. Hotels should emphasize health education in practitioners and the improvement of environmental hygiene. Integrating all three components into a comprehensive environmental promotion program is warranted.

Risk Factors of Healthcare Workers With Coronavirus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China.

Coronavirus Disease 2019 (COVID-19), which originated in Wuhan, China, has caused many healthcare workers (HCWs) to be infected. Seventy-two HCWs manifested with acute respiratory illness were retrospectively enrolled to analyze the risk factors. The high-risk department, longer duty hours, and suboptimal hand hygiene after contacting with patients were linked to COVID-19.

Contactless Food Supply and Delivery System in the COVID-19 Pandemic: Experience from Raytheon Mountain Hospital, China.

The contactless food supply and delivery system of Raytheon Mountain Hospital is an innovative action to solve the dining problem and balance nutrition for medical staff and patients. The system was established according to five approval criteria, including localization, experience in hospital meal service, sufficient raw materials and supporting facilities, food safety, and high execution in dispatching. From the preparation phase to service optimization and improvement, the service model of the full collection of food and beverage information, point-to-point distribution, contactless food delivery, one-stop ordering, and full coverage of separately eating is established to safeguard the contactless food supply and delivery system operating smoothly. As of April 15, 2020 Raytheon Mountain Hospital had been operating safely for 68 days with no occurrence of food safety accident.

Convalescent Plasma-Mediated Resolution of Covid-19 in Humoral Immunodeficiency (preprint)

Convalescent plasma (CP) is widely used to treat Covid-19, but without formal evidence of efficacy. Here, we report the beneficial effects of CP in a severely ill Covid-19 patient with prolonged pneumonia and advanced chronic lymphocytic leukemia (CLL), who was unable to generate an antiviral antibody response of her own. On day-33 after becoming symptomatic, the patient received CP containing high-titer (ID 50 >5,000) neutralizing antibodies (NAbs), defervesced and improved clinically within 48 hours, and was discharged on day-37. Hence, when present in sufficient quantities, NAbs to SARS-CoV-2 have curative potential even if administered relatively late in the disease course.

CT features and clinical manifestations of ordinary pneumonia with COVID-19 infection: A multi-center study (preprint)

Purpose: Investigate clinical and CT manifestations of ordinary coronavirus disease (COVID-19) pneumonia.Materials and methods: Patients with ordinary COVID-19 pneumonia (confirmed by RT-PCR) and performed initial chest CT were retrospectively enrolled. Fifty-eight patients were assigned to group 1 (<50 years, n=33) and group 2 (50≥years, n=25) on the basis of age. The clinical data, laboratory results, and imaging findings were evaluated. Imaging features were analyzed and compared across the two groups.Results: On chest CT imaging, 44 (75.9%) patients showed bilateral lung involvement, 14(24.1%) showed unilateral lung involvement, with predominant peripheral distribution (26/58, 44.8%) and mixed distribution (30/58, 51.7%). 445(445/634, 70.2%) lesions occurred in the lung periphery, 189 (29.8%) in the center. There were more lobes involved in group 2(median 4, IQR 3-5) than group 1(median 3, IQR 1.5-4) (P=0.024). Ground glass opacity (GGO) (451/634, 71.1%) and consolidation (157/634, 24.8%) were the main CT findings. Lesions with a maximum diameter greater than 5cm were more common in group 2 (19/25, 76%) than group 1 (12/33, 36.4%) (P=0.003). The CT score of bilateral lungs, right lung, left lung and each lobe in group 2 was significantly higher than those of group 1 (all P < 0.05), except for the middle lobe of the right lung (P=0.979). Conclusions: Ordinary COVID-19 pneumonia on chest CT generally manifested as multiple GGO and consolidation in the bilateral lung, with predominant peripheral or mixed distribution. Older age might be a risk factor for progression in ordinary COVID-19 pneumonia.

Perceived vulnerability to COVID-19 infection from event attendance: Results from Louisiana, USA, two weeks preceding the national emergency declaration (preprint)

In response to the mounting threat of COVID-19, we added questions to an ongoing food preference study held at Louisiana State University from March 3-12 of 2020. We asked 356 participants: (1) In your opinion, how likely is it that the spread of COVID-19 (the coronavirus) will cause a public health crisis in the United States? (2) How concerned are you that you will contract COVID-19 by attending events on campus? Participants' estimates of an impending national health crisis increased significantly during the study's second week (March 9-12) while concern about personally contracting COVID-19 from attending campus events increased only marginally during the study's final days. We find those expressing a higher likelihood of an impending national crisis were more concerned about contracting COVID-19 by attending campus events, suggesting a possible transmission from perceptions of national-level events to perceived personal vulnerability via local exposure. However, about 30% of participants perceived that COVID-19 would likely cause a public health crisis yet did not express concern about contracting COVID-19 from event attendance. These participants were significantly more likely to be younger students who agreed to participate in response to recruitment using same-day flyer distribution. Women expressed a higher likelihood of an emerging national health crisis, although they were not more concerned than men that attending campus events would result in virus contraction. Other groups (e.g., white, students younger than 25, highest income group) displayed similar concern about a national-level crisis, yet were significantly less concerned about contracting COVID-19 from attending campus events than others. Also, participants randomly assigned to information emphasizing the national impacts of food waste expressed significantly greater concern of contracting COVID-19 by attending campus events. These results provide some initial insight about how people perceived national and personal risks in the early stages of the COVID-19 crisis in Louisiana.

[Clinical features of coronavirus disease 2019 in children: a systemic review of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019]

OBJECTIVE: To systematically summarize the clinical features of coronavirus disease 2019 (COVID-19) in children. METHODS: PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Weipu Database, and Wanfang Database were searched for clinical studies on COVID-19 in children published up to May 21, 2020. Two reviewers independently screened the articles, extracted data, and assessed the risk of bias of the studies included. A descriptive analysis was then performed for the studies. Related indices between children with COVID-19 and severe acute respiratory syndromes (SARS) or Middle East respiratory syndrome (MERS) were compared. RESULTS: A total of 75 studies were included, with a total of 806 children with COVID-19. The research results showed that the age of the children ranged from 36 hours after birth to 18 years, with a male-female ratio of 1.21 : 1. Similar to SARS and MERS, COVID-19 often occurred with familial aggregation, and such cases accounted for 74.6% (601/806). The children with COVID-19, SARS, and MERS had similar clinical symptoms, mainly fever and cough. Some children had gastrointestinal symptoms. The children with asymptomatic infection accounted for 17.9% (144/806) of COVID-19 cases, 2.5% (2/81) of SARS cases, and 57.1% (12/21) of MERS cases. The children with COVID-19 and MERS mainly had bilateral lesions on chest imaging examination, with a positive rate of lesions of 63.4% (421/664) and 26.3% (5/19) respectively, which were lower than the corresponding positive rates of viral nucleic acid detection, which were 99.8% and 100% respectively. The chest radiological examination of the children with SARS mainly showed unilateral lesion, with a positive rate of imaging of 88.9% (72/81), which was higher than the corresponding positive rate of viral nucleic acid detection (29.2%). Viral nucleic acid was detected in the feces of children with COVID-19 or SARS, with positive rates of 60.2% (56/93) and 71.4% (5/7) respectively. The children with COVID-19 had a rate of severe disease of 4.6% (31/686) and a mortality rate of 0.1% (1/806), the children with SARS had a rate of severe disease of 1.5% (1/68) and a mortality rate of 0%, and those with MERS had a rate of severe disease of 14.3% (3/21) and a mortality rate of 9.5% (2/21). CONCLUSIONS: Children with COVID-19 have similar symptoms to those with SARS or MERS, mainly fever and cough. Asymptomatic infection is observed in all three diseases. Children with COVID-19 or SARS have milder disease conditions than those with MERS. COVID-19 in children often occurs with familial aggregation. Epidemiological contact history, imaging examination findings, and viral nucleic acid testing results are important bases for the diagnosis of COVID-19.