COVID-19 Exposure Research Articles

The impact of COVID-19 on routine child immunisation in South Africa

BackgroundThe COVID-19 pandemic disrupted immunisation programs worldwide, reversing gains that had brought vaccine-preventable diseases largely under control. This study explored the impact of COVID-19 on the uptake of routine child immunisation services in South Africa.MethodsWe conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020–2022 and with 12 healthcare providers who provided public immunisation services during the pandemic.ResultsDuring the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities, healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a “bad vaccine” mental model among some caregivers regarding COVID vaccinations, which could lead to doubts about the safety of routine childhood vaccinations.DiscussionThe shift from default to active decision-making highlights a risk that routine immunisation will backslide in future pandemics. Governments should build resilient health systems at all levels and communicate clearly about the benefits and availability of RIs and the safety of vaccinations in general, alongside supply-side interventions.ConclusionRoutine immunisation is widely accepted in South Africa, driven by generational norms and provider recommendations. During the COVID-19 pandemic, many caregivers faced the dilemma of balancing COVID-19 exposure risk with the risk of their child developing a deadly VPD, leading to missed RI visits. This shift to active decision-making highlights a future pandemic risk. Governments should build resilient health systems and focus on understanding and engaging procrastinating and doubtful caregivers. Clear communication about RI benefits and vaccine safety is crucial, as misinformation can lead to distrust in new vaccines.

Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study.

Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children's Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital's capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs' standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies.

Self-Interest over Ethics: Firm Withdrawal from Russia After the Ukraine Invasion

AbstractDrawing on contrasting theoretical perspectives of self-interest and utilitarian/ethical motivations, we examine the degree to which a company's pace of departure from Russia after the Ukraine invasion is driven by its exposure to the Russian market. Moreover, we investigate whether firm-level political and non-political risks influence the propensity to delay or expedite the exit/withdrawal process. Contrary to utilitarian expectations advocating for ethical exit decisions irrespective of exposure and risks, firms with higher Russian exposure were less likely to exit sooner, indicating a prioritization of business interests over ethical imperatives. This self-interest effect was further amplified by heightened political risks but attenuated by non-political risks. These findings remained consistent across various model specifications, with limited discernible variations based on firm characteristics such as ranking, COVID-19 exposure and risk, past idiosyncratic volatility, or family ownership and control. In addition, an examination of post-exit effects on profitability, risk, cost of capital, and liquidity revealed no statistically significant relationships. Our study highlights the prevalence of self-interest motivations over utilitarian principles, as firms with substantial Russian exposure prioritized safeguarding their business interests in the aftermath of the Ukraine invasion, even at the potential cost of ethical and social responsibility imperatives.

An analysis of virtual triage utilization by pregnant women prior to and during the COVID-19 pandemic

ObjectiveThis analysis describes the use patterns of web-based virtual triage (VT) by pregnant patients before and during the first two years of the COVID-19 pandemic, and how the pandemic influenced frequency of VT use, nature of symptoms reported, and the associated implications for maternal healthcare delivery.MethodsAn online survey of 36,910 patients who reported pregnancy was completed between January 1, 2019 and June 30, 2022. The data were segmented into six month periods to allow comparative analyses of usage frequency and changes in initial complaints over the study period, with particular emphasis on the early months of the COVID-19 pandemic. Descriptive statistics and trend analyses were used to identify significant shifts in symptom reporting and user demographics.ResultsA marked increase in the utilization of VT by pregnant women during the pandemic occurred. The percentage of pregnant users grew from 0.32% in the first half of 2019 to 0.85% in late 2021, with the greatest rise (213%) in the first six months of 2020. The most common symptoms reported were abdominal pain, headache, nausea, back pain, fatigue and cough. Pre-pandemic, VT use focused on prospective mothers learning about the potential causes of typical symptoms occurring during pregnancy, but during the pandemic there was a substantial increase in reporting symptoms associated with acute respiratory infections such as cough, nasal congestion, and dyspnea.ConclusionsThe COVID-19 pandemic significantly influenced the use of VT by pregnant women, with a shift towards addressing concerns related to respiratory symptoms and potential COVID-19 exposure. These findings underline the significant role of digital health tools in maintaining access to health information during times of crisis and highlight the evolving needs of pregnant patients in such settings.

An Impact Assessment of Cordon Pricing Relaxation on Modal Shift During the COVID-19 Pandemic

ABSTRACT The COVID-19 pandemic brought significant disruptions to transportation patterns worldwide, with a notable increase in Private Vehicle (PV) usage. Many studies have focused on travel restrictions, while neglecting to consider potential changes in transportation-related policies implemented during COVID-19 that may have improved public health. The present study explores the motivations for modal shifts to PVs and tries to analyze which of the risks of exposure and modifications in transportation policies has caused these modifications. Focusing on the case study of Tehran, Iran, where cordon pricing was relaxed during the pandemic, the study collected data through online and paper-based surveys from 1475 respondents. Binary logit models were employed to analyze the data and understand the impact of destination location, residency area, trip purpose, trip frequency, and vehicle characteristics on modal shift behavior. In addition to COVID-19 exposure as a primary reason for the modal shift, respondents also identified the relaxation of cordon pricing restrictions as a factor that increased the utility of PVs. The study's findings contribute to better understanding the dynamics of travel behavior during pandemics, guiding policymakers in devising effective strategies to address both public health concerns and traffic conditions.

Filipino Rehabilitation Practitioners’ COVID-19 knowledge, practice and attitude: A cross-sectional study

Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).Setting: The study was conducted in the Philippines.Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p 0.000).Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.

STI Rates Among High-Risk Youth Undeterred During Early COVID-19 In A HIV Care Clinic

Abstract Background In recent years, the United States has observed increasing rates of sexually transmitted infections (STIs). Rates are highest amongst the teen and young adult age groups. In addition to the immense healthcare costs associated with STIs, long-term sequelae can be severe on the individual level. The risk of infertility is particularly high for those with repeated or prolonged infection. Upon entering the COVID-19 pandemic, it was unclear if the widespread behavioral changes and disruptions in routine care practices to minimize the further spread of COVID-19 would cause an increase or decrease in the United States’ STI rates. This study sought to determine if there was a change in the incidence of STIs during the first year of the COVID-19 pandemic compared to the year prior in a population at high risk for STIs. Methods A retrospective chart review was performed for 330 patients aged 12 to 41 years (mean 20.2 years, median 20 years, standard deviation 3.75 years) with human immunodeficiency virus (HIV) or on pre-exposure prophylaxis (PrEP) to prevent the acquisition of HIV, who presented for preventative and acute care appointments at a multidisciplinary pediatric and young adult HIV Clinic in the year prior to and during the first year of the COVID-19 pandemic (March 22, 2019-March 21, 2021). Utilizing telehealth, rapid COVID-19 screening, and multimodal patient communication, increased efforts were made in this clinic during the pandemic to maintain appropriate STI screening, testing, treatment, and rescheduling of routine visits when appropriate to minimize COVID-19 exposure and spread. Comparisons were made between the two time periods, which evaluated the incidences of individual and overall STIs diagnosed per person-years, STIs per total tests performed, and time to treatment initiation. Results Between one year prior to and the first year during the COVID-19 pandemic, this clinic experienced no statistically significant rate changes of sexually transmitted infections. A non-significant decreased incidence of chlamydia (22 cases per 100 person-years and 18 cases per 100 person-years, respectively) and unchanged rates of gonorrhea (22 cases per 100 person-years and 22 cases per 100 person-years, respectively) and syphilis (16 cases per 100 person-years and 15 cases per 100 person-years, respectively) were observed. The median times to treatment remained largely unchanged. Conclusion This HIV care clinic experienced a decreased chlamydia infection rate, a trend similar to the CDC United States STI data during this time period. In contrast to the nationally reported increased rates of gonorrhea and syphilis, this clinic experienced unchanged rates. The lack of change in our cohort could reflect that the benefits of a multidisciplinary HIV care model persist despite a pandemic that disrupted routine medical care and behavior practices.

Examining the psychometric properties of the CEFIS-AYA using item response theory.

The COVID-19 Exposure and Family Impact Scale, Adolescent and Young Adult Version (CEFIS-AYA; Schwartz, L. A., Lewis, A. M., Alderfer, M. A., Vega, G., Barakat, L. P., King-Dowling, S., Psihogios, A. M., Canter, K. S., Crosby, L., Arasteh, K., Enlow, P., Hildenbrand, A. K., Kassam-Adams, N., Pai, A., Phan, T. L., Price, J., Schultz, C. L., Sood, E., Wood, J., & Kazak, A. (2022). COVID-19 exposure and family impact scales for adolescents and young adults. Journal of Pediatric Psychology, 47, 631-640. https://doi.org/10.1093/jpepsy/jsac036) was developed to assess the pandemic's effects on adolescents and young adults (AYA). Via principal component analysis, measure developers examined the structure and reliability of the CEFIS-AYA and identified seven exposure and five impact components. This study built upon prior work through use of item response theory (IRT) models to characterize the dimensionality of the CEFIS-AYA, determine the strength of relations between items and underlying trait(s), and examine associations between trait scores and pandemic-related distress. This was a secondary analysis of data collected between July 2020 and July 2021 from three studies of emerging adults (ages 18-29; N = 834). The CEFIS-AYA structure was multidimensional, with the strongest support for five traits. Trait 1 represented pandemic impact on social/emotional functioning and self-care. Trait 2 reflected other pandemic disruptions. Trait 3 represented pandemic disruptions to education and/or other milestones. Trait 4 represented pandemic impact on physical well-being. Trait 5 assessed pandemic disruptions to work/financial circumstances. Item loadings and parameters indicated variability in how consistently trait level was associated with item endorsement. Trait scores did not predict distress, except that increases in Trait 3 were associated with lower distress. The present study examined the psychometric properties of the CEFIS-AYA among emerging adults using a statistical framework better suited for modeling categorical data. The identified dimensional structure was relatively consistent with the initial psychometric evaluation of the CEFIS-AYA, albeit more parsimonious. However, replication is critical in light of sample demographic characteristics.

Seroprevalence of SARS-CoV-2 in pediatric hematology-oncology patients.

The COVID-19 pandemic disproportionately affected persons with underlying medical conditions. SARS-CoV-2 infection susceptibility and vaccine effectiveness in pediatric hematology-oncology patients were unknown. From February to July 2022, anti-spike and anti-nucleocapsid Ig were assayed in 354 pediatric hematology-oncology subjects, including 53 oncology patients receiving chemotherapy (cancer), 150 patients with sickle cell disease (SCD), and 151 benign consult and long-term follow-up patients (controls). Participants completed a questionnaire. Frequencies of COVID-19 infection, defined by positive PCR/antigen test or anti-nucleocapsid Ig, were 62% in cancer, 71% in SCD, 52% in controls, with SCD statistically different than controls (p=.001). Infection was associated with COVID-19 exposure, Hispanic/Latino or Black/African American ethnicity, multi-family dwelling, sports participation; COVID-19 booster decreased association with infection. In COVID-19-positive cancer patients, 58% had positive anti-nucleocapsid and 76% had positive anti-spike (≥10U/mL), compared to essentially 100% seroconversion in SCD and controls (p<.0001, p=.01, respectively). Infection led to high anti-spike (≥2500U/mL) in 12% cancer, 14% SCD, and 15% controls (p=.93). Vaccination resulted in anti-spike positivity in 90% cancer, 100% SCD, and 100% controls (p=.06), and in high anti-spike in 20% cancer, 47% SCD, and 41% controls (p=.36). Of boosted subjects, one of two cancer, 6/6 SCD, and 19/19 controls exhibited high anti-spike. Cancer patients demonstrated similar SARS-CoV-2 infection frequency as controls, but diminished antibody response to infection and vaccination. SCD patients exhibited seroconversion indistinguishable from controls. Vaccination was associated with higher frequency of high anti-spike than infection; vaccination plus booster was most effective in eliciting high anti-spike antibody detectable beyond 90days.

Resilience in Healthcare: A Hospital-based Investigation of Breast Cancer Diagnostics Amid the Pandemic in Indonesia

Background: Widespread disruptions in healthcare services have occurred due to ongoing challenges during the pandemic. The tremendous impacts have struck countries with limited resources, greater distances of geographical access to healthcare services, and a shortage of healthcare personnel. Long delay of diagnosis and disruption in patient care affects the long-term prognosis of breast cancer. This study was conducted to investigate the effects of the COVID-19 pandemic and government-mandated social restrictions on the provision of diagnostic services for breast cancer patients in a tertiary referral hospital. The study aimed to explore how travel restrictions and patients' apprehension about COVID-19 exposure have contributed to notable declines in diagnostic and treatment procedures for breast cancer within this healthcare setting. Methods: This study was retrospective design and used a hospital registry to collect information on demographics, imaging, and pathology from January 2018 to September 2021. Breast ultrasound (US) and mammography data were collected from the Picture Archiving and Communication System (PACS), while pathology data were collected from e-medical records. The descriptive statistics of the annual total volume of imaging and pathological examinations were interpreted and statistics were only calculated for diagnostics mammography. Results: Between 2018 and 2021, the volume of monthly breast sonograms drastically decreased by 65% in 2020 and 2021 during the pandemic, while mammography significantly reduced by more than 40% from the 2019 levels. Breast US and mammography procedures were significantly lower during the first and second waves of the pandemic in March until May 2020 and June until September 2021, respectively. Although the proportion of breast ultrasound-guided fine-needle aspiration biopsy (FNAB) increased year by year, the number of FNAB for primary breast lesions significantly decreased by 84% in 2020 and 2021. Conclusions: We observed significant decreases in diagnostic procedures for breast cancer. Reconfiguration of breast cancer care scheduling is required to accommodate the potential for increased hospital visits after the travel restrictions.

COVID-19 exposure, financial flexibility, and corporate leverage adjustment

This study examines how firm-level exposure to the COVID-19 pandemic affects the speed of leverage adjustment among 3260 US-listed firms from 2019q1 to 2022q1. Using a novel measure of COVID-19 exposure, we find that higher exposure significantly reduces the speed at which firms adjust their leverage towards target levels. This effect is more pronounced for financially constrained firms and those operating in competitive markets. We further show that COVID-19 exposure adversely impacts corporate liquidity, default risk, and financial flexibility. Our findings highlight the role of exogenous shocks in shaping corporate financing decisions.

Quantifying and Adjusting for Confounding From Health-Seeking Behavior and Health Care Access in Observational Research.

Health-seeking behavior and health care access (HSB/HCA) are recognized confounders in many observational studies but are not directly measurable in electronic health records. We used proxy markers of HSB/HCA to quantify and adjust for confounding in observational studies of influenza and COVID-19 vaccine effectiveness (VE). This cohort study used primary care data prelinked to secondary care and death data in England. We included individuals aged ≥66 years on 1 September 2019 and assessed influenza VE in the 2019-2020 season and early COVID-19 VE (December 2020-March 2021). VE was estimated with sequential adjustment for demographics, comorbidities, and 14 markers of HSB/HCA. Influenza vaccination in the 2019-2020 season was also considered a negative control exposure against COVID-19 before COVID-19 vaccine rollout. We included 1 991 284, 1 796 667, and 1 946 943 individuals in the influenza, COVID-19, and negative control exposure populations, respectively. Markers of HSB/HCA were positively correlated with influenza and COVID-19 vaccine uptake. For influenza, adjusting for HSB/HCA markers in addition to demographics and comorbidities increased VE against influenza-like illness from -1.5% (95% CI, -3.2% to .1%) to 7.1% (95% CI, 5.4%-8.7%) with a less apparent trend for more severe outcomes. For COVID-19, adjusting for HSB/HCA markers did not change VE estimates against infection or severe disease (eg, 2 doses of BNT162b2 against infection: 82.8% [95% CI, 78.4%-86.3%] to 83.1% [95% CI, 78.7%-86.5%]). Adjusting for HSB/HCA markers removed bias in the negative control exposure analysis (-7.5% [95% CI, -10.6% to -4.5%] vs -2.1% [95% CI, -6.0% to 1.7%] before vs after adjusting for HSB/HCA markers). Markers of HSB/HCA can be used to quantify and account for confounding in observational vaccine studies.

Impact of COVID-19 on psychological distress in subsequent stages of the pandemic: The role of received social support.

This longitudinal study examined a sample of adult Poles (N = 1245), who were interviewed three times from July 2021 to August 2022, during the later stages of the COVID-19 pandemic. The study had two primary objectives. The first was to assess the impact of the pandemic on psychological distress, measured through symptoms of depression and anxiety. The pandemic's effects were evaluated using three predictors: direct exposure to COVID-19, COVID-19 related stressors, and perceived threats from COVID-19. The second objective was to investigate the role of received social support in coping with the pandemic's hardships. Receipt of social support was measured by both the quantity of help received and the perceived quality of that support. A Latent Growth Curve Model (LGCM) was employed to analyze psychological distress across three waves, controlling for sociodemographic variables, non-COVID life events, coping self-efficacy, and perceived social support. Findings indicated that COVID-19 stressors and COVID-19 threats were strongly and consistently associated with greater psychological distress throughout the study period. The impact of direct COVID-19 exposure was limited. The quantity of received support predicted higher distress, whereas higher quality of received support was linked to better mental health. Crucially, the relationship between the quantity of support and distress was moderated by the quality of support. Effective social support was associated with the lowest distress levels, regardless of the amount of help received. Conversely, receiving large amounts of low-quality support was detrimental to psychological health. In summary, the ongoing psychosocial challenges of COVID-19 significantly eroded mental health, highlighting the importance of support quality over quantity in coping with significant life adversities.

Informed consent and coercion in recruitment advertisements for oocyte donors

BackgroundAs the use of donor eggs for in vitro treatment has increased, both medically affiliated and private donor egg agencies have turned to online advertisements to recruit donors. The American Society for Reproductive Medicine provides recommendations encouraging ethical recruitment of donors, however there is no formal regulation for the informed consent process for egg donor recruitment and compensation. Underrepresentation of risks and targeted financial incentives may pose a risk to the informed consent process.MethodsData from online advertisements for egg donors active between January 1 - August 31, 2020, were collected to analyze content related to risks, Covid-19 precautions, donor payment, and desired donor characteristics. Advertisements for egg donors on Google, Craigslist, and social media were analyzed. Primary outcomes included the mention of the risks of egg donation, including the risk of Covid-19 exposure, in donor egg advertisements. Secondary outcomes included language targeting specific donor characteristics and financial compensation.Results103 advertisements were included. 35.9% (37/103) of advertisements mentioned some risk of the egg donation process, and 18.5% (19/103) mentioned risks or precautions related to Covid-19 exposure. Of advertisements for private donor egg agencies, 40.7% (24/59) mentioned any risk, compared to 29.6% (13/44) of medically affiliated egg donation programs; the difference was not statistically significant (p-value = 0.24). Agencies targeting students and donors of a specific race were more likely to offer payments over $10,000 for an egg donation cycle. Among advertisements offering over $20,000 for donor compensation, 72.7% (8/11) recruited women under the age of 21.ConclusionEgg donor recruitment advertisements, for both medically affiliated programs and private agencies, were unlikely to mention risks including the risk of exposure to Covid-19. Non-medically affiliated private donor egg agencies were more likely to violate multiple American Society for Reproductive Medicine ethics guidelines, including offering higher than average compensation, and recruiting donors from young and vulnerable populations.

Influence of previous COVID-19 exposure and vaccine type (CoronaVac, ChAdOx1 nCov-19 or BNT162b2) on antibody and cytokine (Th1 or Th2) responses

ABSTRACT To achieve global herd immunity, widespread vaccination is the most effective strategy. Vaccines stimulate the immune system, generating cytokines and chemokines, isotype antibodies, and neutralizing antibodies; all these molecules collectively provide a more comprehensive characterization of the immune response post-vaccination. We conducted a longitudinal study in northwestern Mexico, involving 120 individuals before vaccination and after the first dose of the SARS-CoV-2 vaccine, and 46 individuals after their second dose. Our findings reveal that antibody levels stabilize over time; cytokine levels generally increase following the first dose but decrease after the second dose and higher than normal levels in IgG1 and IgG3 concentrations are present. Most of the innate cytokines determined in this study were higher after the first dose of the vaccine. Regardless of previous infection history, this finding suggests that the first dose of the vaccine is crucial and may stimulate immunity by enhancing the innate immune response. Conversely, increased levels of IL-4, indicative of a Th2 response, were found in individuals without prior exposure to the virus and in those vaccinated with CoronaVac. These results suggest that the immune response to COVID-19 vaccines is multi-faceted, with preexisting immunity potentiating a more robust innate response. Vaccine type plays a critical role, with genetic vaccines favoring a Th1 response and inactivated vaccines like CoronaVac skewing toward a Th2 profile.

The Effect of COVID-19 on Lung Cancer Screening.

Background During the COVID-19 pandemic, many hospitals suspended non-essential medical procedures to reduce transmission and prioritize personal protective equipment (PPE) for COVID-19 patients. Hospitals that continued these procedures faced uncertainty about patient attendance. Multiple factors could explain a decline in patient attendance during the pandemic, including patients' reluctance to risk COVID-19 exposure in the hospital or their own illness requiring self-isolation. This study aimed to compare attendance rates of lung cancer screenings (LCS) before and during the pandemic. Unlike previous studies conducted on this research topic, the current study documents that the John B. Amos Cancer Center continued LCS throughout the pandemic.The alternative hypothesis was that there would be a decrease in the percentage of LCS performed during the pandemic period due to fear of nosocomial transmission. Materials and methods Data for 2,582 scheduled LCS were retrospectively analyzed on Microsoft Excel 2022(Microsoft Corporation, Redmond, Washington) from 2018 to 2021. For analysis purposes, 2018 and 2019 were considered pre-COVID years, while 2020 and 2021 were considered COVID years. The average percentage attended was calculated for each year and the standard deviation of that year's percentage. The percentage of patients seen each month was averaged during pre-COVID and COVID years. The p-value was calculated by comparing the average attendance percentage for each month in the pre-COVID and COVID years. A p-value <0.05 was considered significant. Results From 2018 to 2021, over 300 more people were scheduled during the COVID years. Although the percentage seen remained consistent throughout the years, there was an increase in both patients scheduled and seen. The results revealed an insignificant difference in LCS attendance between pre-COVID and COVID years, confirming the importance of their continuation. Conclusion The alternative hypothesis was rejected due to no significant difference in attendance percentage between the pre-COVID and COVID years. Further direction of this study may include monitoring the trend of LCS attendance during post-pandemic years as the transmission rates continue to change.

Impact of the COVID-19 pandemic on the quality of care for juvenile idiopathic arthritis patients: insights from Thailand

BackgroundThe COVID-19 pandemic has significantly impacted individuals with chronic conditions. This investigation assessed the quality of care provided to pediatric and adolescent patients with juvenile idiopathic arthritis (JIA) during the pandemic in Thailand.MethodsThis cross-sectional analysis enrolled JIA patients aged ≤ 18 years at an academic tertiary care facility from April 2022 to March 2023. Retrospective reviews were performed, complemented by patient and caregiver questionnaires to assess the pandemic’s impact on care quality.ResultsSeventy JIA patients (37 males, 33 females) with a mean age of 13.5 ± 3.1 years were included. A total of 41.4% of the caregivers reported negative impacts on JIA care due to the pandemic and the lockdown, and 31.4% of the patients experienced pandemic-related anxiety. A comparison between the pandemic and prepandemic periods revealed a higher incidence of active disease, although the difference was statistically nonsignificant (37.1% vs 14.2%, p = 0.106). Nonadherence significantly predicted active disease status (adjusted OR 15.04, 95% CI 2.48–91.15, p = 0.03). COVID-19 vaccinations were administered to 85.7% of patients; 52.8% of whom contracted mild COVID-19. Most patients (71.4%) postponed clinic visits; 36% due to lockdowns and 28% due to concerns about COVID-19 exposure in healthcare settings. The majority of patients received telephone JIA management advice from rheumatologists during the lockdown (91.4%).ConclusionsThe COVID-19 pandemic and associated lockdown measures affected the care of JIA patients, impacting both physical and mental health. Nonadherence was a critical factor in disease flare-ups. Telemedicine is indispensable for patient care.

Interim safety and immunogenicity analysis of the EuCorVac-19 COVID-19 vaccine in a Phase 3 randomized, observer-blind, immunobridging trial in the Philippines.

EuCorVac-19 (ECV-19) is a recombinant receptor binding domain (RBD) COVID-19 vaccine that displays the RBD (derived from the SARS-CoV-2 Wuhan strain) on immunogenic liposomes. This study compares the safety and immunogenicity of ECV-19 to the COVISHIELDTM (CS) adenoviral-vectored vaccine. Interim analysis is presented of a randomized, observer-blind, immunobridging Phase 3 trial in the Philippines in 2600 subjects, with treatment and biospecimen collection between October 2022 and January 2023. Healthy male and female adults who received investigational vaccines were 18 years and older, and randomly assigned to ECV-19 (n = 2004) or CS (n = 596) groups. Immunization followed a two-injection, intramuscular regimen with 4 weeks between prime and boost vaccination. Safety endpoints were assessed in all participants and immunogenicity analysis was carried out in a subset (n = 585 in ECV-19 and n = 290 in CS groups). The primary immunological endpoints were superiority of neutralizing antibody response, as well as noninferiority in seroresponse rate (defined as a 4-fold increase in RBD antibody titers from baseline). After prime vaccination, ECV-19 had a lower incidence of local solicited adverse events (AEs) (12.0% vs. 15.8%, p < 0.01), and solicited systemic AEs (13.1 vs. 17.4%, p < 0.01) relative to CS. After the second injection, both ECV-19 and CS had lower overall solicited AEs (7.8% vs. 7.6%). For immunological assessment, 98% of participants had prior COVID-19 exposure (based on the presence of anti-nucleocapsid antibodies) at the time of the initial immunization, without differing baseline antibody levels or microneutralization (MN) titers against the Wuhan strain in the two groups. After prime vaccination, ECV-19 induced higher anti-RBD IgG relative to CS (1,464 vs. 355 BAU/mL, p < 0.001) and higher neutralizing antibody response (1,303 vs. 494 MN titer, p < 0.001). After boost vaccination, ECV-19 and CS maintained those levels of anti-RBD IgG (1367 vs. 344 BAU/mL, p < 0.001) and neutralizing antibodies (1128 vs. 469 MN titer, p < 0.001). ECV-19 also elicited antibodies that better neutralized the Omicron variant, compared to CS (763 vs. 373 MN titer, p < 0.001). Women displayed higher responses to both vaccines than men. The ECV-19 group had a greater seroresponse rate compared to CS (83% vs. 30%, p < 0.001). In summary, both ECV-19 and CS had favorable safety profiles, with ECV-19 showing diminished local and systemic solicited AE after prime immunization. ECV-19 had significantly greater immunogenicity in terms of anti-RBD IgG, neutralizing antibodies, and seroresponse rate. These data establish a relatively favorable safety and immunogenicity profile for ECV-19. The trial is registered on ClinicalTrials.gov (NCT05572879).

The Need for a Model of Accompanying Family Members for Elderly with Covid-19 During Isolation at Sembiring Delitua Public Hospital North Sumatera, Indonesia to Avoid Anxiety

Background: Older adults are a population more prone to anxiety when placed in isolation in hospitals because of COVID-19 exposure. This worry may jeopardize the mental well-being of senior Covid-19 patients. Aim: To preserve mental health in older individuals with Covid-19, anxiety treatment is essential. Providing support to family members during hospital isolation can help older patients overcome their fear. Methods: The investigators employed various methodologies to conduct the investigation. We developed a retrospective model because we couldn't conduct testing. The study examined isolated elderly patients who received assistance versus those who did not. Each group in the quantitative study included 11 elderly individuals, with the case group comprising 10 nurses and 11 companions. Results: The study revealed that older individuals who received support from their children during isolation experienced less anxiety compared to those who did not receive such assistance, the difference is significant. Conclusion: Older adults with Covid-19 who get support from their kids while undergoing inpatient confinement can conquer fear. To ensure effective recovery for their elderly loved ones, family members must visit, communicate with, and aid them during hospital isolation.

Quantifying wildland fire resources deployed during the compound threat of COVID-19

Fire agencies across the United States must make complex resource allocation decisions to manage wildfires using a national network of shared firefighting resources. Firefighters play a critical role in suppressing fires and protecting vulnerable communities. However, they are exposed to health and safety risks associated with fire, smoke inhalation, and infectious disease transmission. The COVID-19 pandemic further complicated these risks, prompting fire agencies to propose resource management adaptations to minimize COVID-19 exposure and transmission. It is unclear if and how the pandemic may have operationally influenced wildland firefighting personnel resource use given compounding wildfire and COVID-19 risks. Therefore, we developed generalized linear mixed models that were fit using multiple integrated datasets to detect changes in personnel resource use for years prior to and during the COVID-19 pandemic, while controlling for historical fire and landscape conditions, societal risks, and management objectives. Analyses of observed and predicted firefighting resource use revealed reductions in the mean personnel resources used per wildfire per day during the pandemic for models developed across the western U.S. and for various western U.S. fire regions. Notably, the Northern California and the Great Basin Coordination Centers showed statistically significant reductions in ground personnel use during the COVID-19 pandemic. Learning from wildland fire management strategies and resource use trends that occurred during the COVID-19 pandemic, fire agencies can better anticipate resource constraints that may arise during the compounding threats of severe wildland fire activity and infectious disease outbreaks to proactively prepare and adapt suppression management strategies.