Persistence of pneumococcal carriage among older adults in the community despite COVID-19 mitigation measures

BackgroundReported rates of invasive pneumococcal disease were markedly lower than normal during the 2020/2021 winter in the Northern Hemisphere, the first year after the start of the COVID-19 pandemic. However, little is known about rates of carriage of pneumococcus among adults during this period. MethodsBetween October 2020-August 2021, couples living in the Greater New Haven Area were enrolled if both individuals were aged 60 years and above and did not have any individuals under the age of 60 years living in the household. Saliva samples and questionnaires regarding social activities and contacts and medical history were obtained every 2 weeks for a period of 10 weeks. Following culture-enrichment, extracted DNA was tested using qPCR for pneumococcus-specific sequences piaB and lytA. Individuals were considered positive for pneumococcal carriage when Ct-values for piaB were less than 40. ResultsWe collected 567 saliva samples from 95 individuals aged 60 years and above (47 household pairs and one singleton). Of those, 7.1% of samples tested positive for pneumococcus by either piaB only (n=6) or both piaB and lytA (n=34), representing 22/95 (23.2%) individuals and 16/48 (33.3%) households over the course of the 10-week study period. Study participants attended few social events during this period. However, many participants continued to have regular contact with children. Individuals who had regular contact with preschool and school aged children (i.e., 2-9 year olds) had a higher prevalence of carriage (15.9% vs 5.4%). ConclusionsDespite COVID-19-related disruptions, a large proportion of older adults carried pneumococcus at least once during the 10-week study period. Prevalence was particularly high among those who had contact with school-aged children, but carriage was not limited to this group.

Strict Physical Distancing May Be More Efficient: A Mathematical Argument for Making Lockdowns Count

COVID-19 created a global public health and economic emergency. Policymakers acted quickly and decisively to contain the spread of disease through physical distancing measures. However, these measures also impact physical, mental and economic well-being, creating difficult trade-offs. Here we use a simple mathematical model to explore the balance between public health measures and their associated social and economic costs. Across a range of cost-functions and model structures, commitment to intermittent and strict social distancing measures leads to better overall outcomes than temporally consistent implementation of moderate physical distancing measures. With regard to the trade-offs that policymakers may soon face, our results emphasize that economic and health outcomes do not exist in full competition. Compared to consistent moderation, intermittently strict policies can better mitigate the impact of the pandemic on both of these priorities for a range of plausible utility functions.

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises.

BACKGROUND: Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. METHODS: The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. RESULTS: Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. CONCLUSIONS: These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of a quality assurance system that are most correlated with improved quality of clinical care for patients.

Arterial desaturation syndrome following pleurodesis with talc slurry: incidence, clinical features, and outcome.

The objectives were to define the incidence, risk factors, clinical features and outcome of arterial desaturation syndrome following talc pleurodesis in patients with malignant pleural effusions. This retrospective, observational study took place at a tertiary care cancer center in New York. All patients were those with malignancy who underwent pleurodesis with talc in 1998 at Memorial Sloan Kettering Cancer Center. Characteristics of patients are described by using summary statistics. Differences between groups were assessed with the Fisher's exact statistic for categorical variables and Student's t-test for continuous variables. Among patients who were considered to have arterial desaturation syndrome, we evaluated the relation of SaO2/FIO2 pre- and post-talc installation using a paired Student's t-test. During 1998, 120 patients underwent pleurodesis with talc, and 8 (7%) developed arterial desaturation following the procedure. Symptoms included chest pain, dyspnea, fever, and increased need for oxygen supplementation developed typically within 1 day. Three of the eight patients in this series required mechanical ventilation, but all recovered uneventfully after treatment, which included high-dose corticosteroids. Patients with breast and ovarian cancer appeared to be at increased risk for this complication compared to those patients with other types of cancer (p = 0.01). Approximately 7% of patients who have undergone sclerosis with talc for a malignant pleural effusion will develop arterial desaturation with clinically significant hypoxia requiring supplemental oxygen following the procedure. It appears that most patients recover from this complication and that those with breast and ovarian cancer may be at higher risk.