Epicenter Of COVID-19 Research Articles

Lessons Learned From an Anatomic Pathology Department in a Large Academic Medical Center at the Epicenter of COVID-19

Many state-wide, city-wide, and hospital-wide changes have been implemented due to the ongoing COVID-19 crisis. We describe lessons learned in an anatomic pathology division at a tertiary care center during the peak of the COVID-19 pandemic in the hopes that knowledge of our experiences can benefit other pathology departments as they encounter this pandemic. Five categories that are critical in strategic planning for the COVID-19 pandemic are discussed: workload, departmental policy revisions, impact on faculty, workforce staffing, and impact on educational programs, including residency and fellowship training. Although the volume of COVID-19 testing had grown placing increased demands on the clinical pathology laboratory, the volume of anatomic pathology cases had declined during the COVID-19 peak. Lessons learned were widespread including changes in the anatomic pathology workflow due to declining surgical and cytologic case volumes and increases in autopsy requests. Modifications were required in gross room policies, levels of personal protective equipment, and workforce. Travel and meeting policies were impacted. Adaptations to residency and fellowship programs were vast and included innovations in didactic and interactive education. We must learn from our experiences thus far in order to move forward, and we hope that our experiences in an anatomic pathology department in the epicenter of the COVID-19 pandemic can help other pathology departments across the country.

Clinical and therapeutic outcomes of COVID-19 intensive care units (ICU) patients: a retrospective study in Ghana.

The COVID-19 pandemic had caused significant morbidity and mortality, with over a million deaths recorded to date. Mortality recorded among severe-critically ill patients admitted to intensive care units (ICU) has been significantly high, especially in most COVID-19 epicenters. Reports on the unique clinical characteristics and outcomes from the ICU admissions are on-going with isolated studies in Africa. This study was a retrospective single-centre study involving all polymerase chain reaction (PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients admitted to the medical intensive care unit (MICU) of the department of medicine and therapeutics, Korle-Bu Teaching Hospital, over the period of 13th April - 28th June 2020. Twenty-two (22) patients in total fulfilled the inclusion criteria and are included in this report. Patients' socio-demographic characteristics, clinical and laboratory parameters outcomes as well as treatment modalities employed were extracted from their respective medical records and analyzed using STATA version 14. Dyspnoea, fever and cough were most common associated symptoms. The mean duration of admission at the ICU was 4.1 ± 3.0 days with five deaths (22.7%). About 91% (20/22) had at least one comorbidity with hypertension as the most prevalent. The median oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) level was significantly higher in persons with only COVID-19 pneumonia compared to those with complicated respiratory failure (p<0.001). Six (27.3%) out of the 22 patients had non-invasive ventilation, with only 1/22 (4.5%) receiving mechanical ventilation. Although non-significant, the mean duration of ICU stay was relatively shorter in patients who received therapeutic doses of anticoagulation (p=0.32). Duration of treatment with methylprednisolone was significantly associated with patient outcomes (p=0.04) and serum ferritin levels had a tendency to negatively affect outcome (p=0.06). Clearly there are still no specific targeted medications for COVID-19 treatment, except for empirically symptoms-guided treatments and management of mild to critically ill patients. Early use of systemic corticosteroids for severe to critically ill patients in the ICU using S/F ratio and CRP levels may improve outcomes.

"Cuba's Medical Team in the European Epicenter of COVID-19: Carlos R. Pérez-Díaz MD MS PhD Director, Joaquín Albarrán Provincial Clinical-Surgical Hospital, Havana Henry Reeve Medical Contingent Leader, Lombardy, Italy".

On March 23, 2020, Cuba's Henry Reeve Emergency Medical Contingent began treating COVID-19 patients at Maggiore Hospital in Crema, Lombardy. Within days, the 52-member contingent comprised of 36 doctors and 15 nurses (plus 1 logistics specialist), together with Italian colleagues, were receiving patients in an adjacent fi eld hospital established and equipped for this purpose. At the time, Lombardy was the epicenter of COVID-19 transmission in Europe. Many of the Cubans in Lombardy were Contingent veterans, having served in postdisaster and epidemic scenarios in Chile, Pakistan, Haiti and elsewhere since the founding of the emergency medical team in 2005. Importantly, some had worked fi ghting the 2014 Ebola epidemic in West Africa. Even so, providing medical care during COVID-19 is a unique challenge, the likes of which had never before been seen by the Cuban team. Dr Carlos R. Pérez-Díaz, one of the Contingent's founding members, headed the team during its 60-day rotation in Lombardy, drawing on a wide array of professional experience. From 2006 to 2009, Dr Pérez-Díaz led the Cuban team posted at the Peltier Hospital in Djibouti, where he worked in the infectious disease department; in 2008, this team helped control a cholera outbreak that had spread to three countries. Following the 2010 earthquake in Chile, Dr Pérez-Díaz headed the team of Henry Reeve volunteers that provided free health services for 10 months in a tent hospital established to treat victims; he returned to Chile in 2015, again as head of the Henry Reeve Contingent, after severe fl ooding struck the Atacama region.

Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis.

Rationale: Initial reports of case fatality rates (CFRs) among adults with coronavirus disease (COVID-19) receiving invasive mechanical ventilation (IMV) are highly variable.Objectives: To examine the CFR of patients with COVID-19 receiving IMV.Methods: Two authors independently searched PubMed, Embase, medRxiv, bioRxiv, the COVID-19 living systematic review, and national registry databases. The primary outcome was the “reported CFR” for patients with confirmed COVID-19 requiring IMV. “Definitive hospital CFR” for patients with outcomes at hospital discharge was also investigated. Finally, CFR was analyzed by patient age, geographic region, and study quality on the basis of the Newcastle-Ottawa Scale.Measurements and Results: Sixty-nine studies were included, describing 57,420 adult patients with COVID-19 who received IMV. Overall reported CFR was estimated as 45% (95% confidence interval [CI], 39–52%). Fifty-four of 69 studies stated whether hospital outcomes were available but provided a definitive hospital outcome on only 13,120 (22.8%) of the total IMV patient population. Among studies in which age-stratified CFR was available, pooled CFR estimates ranged from 47.9% (95% CI, 46.4–49.4%) in younger patients (age ≤40 yr) to 84.4% (95% CI, 83.3–85.4%) in older patients (age >80 yr). CFR was also higher in early COVID-19 epicenters. Overall heterogeneity is high (I2 >90%), with nonsignificant Egger’s regression test suggesting no publication bias.Conclusions: Almost half of patients with COVID-19 receiving IMV died based on the reported CFR, but variable CFR reporting methods resulted in a wide range of CFRs between studies. The reported CFR was higher in older patients and in early pandemic epicenters, which may be influenced by limited ICU resources. Reporting of definitive outcomes on all patients would facilitate comparisons between studies.Systematic review registered with PROSPERO (CRD42020186997).

Surge-in-Place: Conversion of a Cardiac Catheterization Laboratory Into a COVID-19 Intensive Care Unit and Back Again.

In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.

Neuro-oncology practice guidelines from a high-volume surgeon at the COVID-19 epicenter

BackgroundDuring the coronavirus 19 (COVID-19) pandemic, physicians have begun adapting their daily practices to prevent transmissions. In this study we aimed to provide surgical neuro-oncologists with practice guidelines during the COVID-19 pandemic based on objective data from a high-volume brain tumor surgeon at the current COVID-19 epicenter. MethodsAll outpatient visits and surgeries performed by the senior author during the COVID-19 pandemic were compared between the initial quarantine (3/23/20–5/4/20), the plateau period following quarantine (5/5/20–6/27/20), and the second peak (6/28/20–7/20/20). In-person and telemedicine visits were evaluated for crossovers. Surgeries were subdivided based on lesion type and evaluated across the same time period. ResultsFrom 3/23/20–7/20/20, 469 clinic visits and 196 surgeries were identified. After quarantine was lifted, face-to-face visits increased (P < 0.01) yet no change in telehealth visits occurred. Of 327 telehealth visits, only 5.8% converted to in-person during the 4-month period with the most cited reason being patient preference (68.4%). Of the 196 surgeries performed during the pandemic, 29.1% occurred during quarantine, 49.0% during the plateau, and 21.9% occurred in the second peak. No COVID negative patients developed symptoms at follow-up. 55.6% were performed on malignant tumors and 31.6% were benign with no difference in case volumes throughout the pandemic. ConclusionsDespite exceptional challenges, we have maintained a high-volume surgical neuro-oncology practice at the epicenter of the COVID-19 pandemic. We provide the protocols implemented at our institution in order to maximize neuro-oncology care while mitigating risk of COVID-19 exposure to both patients and providers.

Сложность патогенеза коагулопатии при COVID-19

Введение. Коронавирус SARS-CoV-2 является новым вирусом, обладающим способностью осуществлять трансмиссию воздушно-капельным путем, вызывая тяжелое течение атипичной пневмонии, нередко сочетающейся с коагулопатиями. Роль структурных белков коронавируса в их патогенезе неизвестна. Цель исследования: с помощью биоинформационного анализа выявить в структурных белках коронавируса SARS-CoV-2 последовательности, гомологичные белкам системы гемостаза, и рассмотреть возможные сценарии их участия в патогенезе коагулопатий при COVID-19, а также объяснить существование вирусостатического эффекта гепарина. Материалы и методы. Для компьютерного анализа были использованы доступные в Интернете базы данных первичных структур белков коронавирусов и их рецепторов, а также поверхностных белков других вирусов, белков системы гемостаза и иммунной системы. Сравнивали аминокислотный состав белков и распределение оснόвных аминокислот (аргинина и лизина) в их первичных последовательностях. С целью выявления пептидного (иммуноэпитопного) родства структурных белков коронавирусов с белками системы гемостаза человека был выполнен поиск гомологичных последовательностей в их белках. Результаты. В структурных белках коронавируса SARS-CoV-2 выявлено множество последовательностей, гомологичных белкам системы гемостаза и иммунной системы. В отличие от коронавирусов SARS-CoV и MERS-CoV, S1-субъединица S-белка коронавируса SARS-CoV-2 имеет положительную полярность. Заключение. Множество последовательностей в структурных белках коронавируса SARS-CoV-2, гомологичных белкам системы гемостаза, потенциально способны вы- зывать различные сценарии патогенеза коагулопатий. Положительная полярность S1-субъединицы S-белка коронавируса SARS-CoV-2 позволяет объяснить неспецифическое взаимодействие ее с гепарином и его вирусостатический (неантикоагулянтный) эффект. Background. The coronavirus SARS-CoV-2 is a new virus capable of human-human transmission and inducing a severe atypical pneumonia often associated with coagulopathy. A role of SARS-CoV-2 structural proteins in coagulopathy pathogenesis is unknown. Objectives: to use a bioinformation analysis to identify SARS-CoV-2 sequences in the structural proteins that are homologous to hemostasis system proteins, regard their possible participation in coagulopathy pathogenesis and explain the antiviral effect of heparin. Materials / Methods. For computer analysis, Internet databases were used of the primary structures of coronavirus proteins and their receptors, as well as surface proteins of other viruses, proteins of hemostasis and immune systems. The amino acid composition of proteins and the distribution of basic amino acids (arginine and lysine) in their primary sequences were compared. For detection of peptide (immunoepitopic) relationship of coronaviruses structural proteins with human hemostasis proteins, a search for homologous sequences in their proteins was performed. Results. Many sequences have been identified in structural proteins of SARS-CoV-2 coronavirus that are homologous to the proteins of hemostasis and immune systems. In contrast with SARS-CoV and MERS-CoV coronaviruses, the S1-subunit of SARS-CoV-2 coronavirus S-protein has a positive polarity. Conclusions. Many sequences in SARS-CoV-2 structural proteins that homologous to hemostasis system proteins are potentially responsible for coagulopathy pathogenesis. The positive polarity of the S1-subunit of SARS-CoV-2 S-protein explains its nonspecific interaction with heparin and its virostatic (non-anticoagulant) effect.

Resumption of Elective Orthopaedic Surgery in the US Epicenter of COVID-19.

On March 1, 2020, New York State confirmed its first case of COVID-19. This state has had the largest initial mortality in the United States with more than 479,000 confirmed cases and over 25,000 deaths as of October 10, 2020. All elective surgeries in New York State were suspended on March 23, 2020, due to the national state of emergency. Syosset Hospital is a 75-bed community hospital dedicated primarily to elective surgery. During the COVID-19 surge, the hospital was converted to provide needed beds for the treatment of COVID-19 illness. In anticipation of the resumption of urgent elective procedures, this hospital became one of the two designated sites within the Northwell Health system to be “non-COVID.” Once the hospital was emptied of all inpatients, a complete and thorough cleaning and disinfection was performed on the entire building. All equipment was thoroughly decontaminated following Centers for Disease Control and Prevention (CDC) guidelines. In anticipation of the resumption of elective surgery, each surgeon evaluated their cancelled case list to determine patient priority, based on a scale of 1 (elective, non-urgent), 2 (semi-urgent), 3 (urgent), to 4 (highly urgent). Site-specific disaster credentialing was expedited so that emergent surgeries could be performed by surgeons located at other Northwell sites. To ensure a structured and informative onboarding process, each visiting surgeon received a “welcome” email which requested pertinent information to facilitate the surgical process. Presurgical, surgical, and postoperative protocols were revised based on federal and local guidance and regulations. Resumption of elective surgery post COVID-19 placed the hospital into uncharted territory.

How Do You Provide Humanistic Care During a Pandemic?

Because of the COVID-19 pandemic, we are at an unprecedented time in history. We practice at Monter Cancer Center in Lake Success, New York, which is part of Northwell Health, the largest health system in New York state, located in the initial epicenter of COVID-19 in the United States.

Viral Encounters: Xenophobia, Solidarity, and Place-based Lessons from Chinese Migrants in Italy

Migrant and refugee populations have been identified as among the most vulnerable to COVID-19 due to what medical anthropologists have described as structural vulnerability. We argue significant differences exist between migrant groups and offer lessons for society at large. We develop the concept of viral encounters to frame an analysis of social narratives, representations, and practices involved in coping with threats of transmission and practices of prevention. Specifically, the globalized city of Prato offers a case study due to its unique relationship with COVID-19. Instead of a COVID-19 epicenter, however, Prato emerged as a contagion exception particularly as related to its Chinese migrant community. We use a place-based framework to argue that the threat of xenophobia, preparedness with quarantine, and the will of solidarity motivated an entire migrant community to take action—well before the nationwide lockdown began and extending beyond its conclusion. We combine virtual ethnography with health data as well as evidence of xenophobia and solidarity to offer an analysis. We argue that the effects of solidarity reconfigure dominant ideologies of individualism, open space for collective orientation toward a human economy, and offer potential to alleviate detrimental impacts of pandemics.

Impact of COVID-19 on the Healthcare of Patients With Inflammatory Bowel Disease: A Comparison Between Epicenter vs. Non-epicenter Areas.

Background and Aims: The COVID-19 pandemic poses a great challenge to healthcare. We aimed to investigate the impact of COVID-19 on the healthcare of patients with inflammatory bowel disease (IBD) in epicenter and non-epicenter areas.Methods: Patients with IBD from Hubei province (the epicenter of COVID-19) and Guangdong province (a non-epicenter area), China were surveyed during the pandemic. The questionnaire included change of medications (steroids, immunomodulators, and biologics), procedures (lab tests, endoscopy, and elective surgery), and healthcare mode (standard healthcare vs. telemedicine) during 1 month before and after the outbreak of COVID-19.Results: In total, 324 IBD patients from Guangdong province (non-epicenter) and 149 from Hubei province (epicenter) completed the questionnaire with comparable demographic characteristics. Compared to patients in Guangdong province (non-epicenter), significantly more patients in Hubei (epicenter) had delayed lab tests/endoscopy procedures [61.1% (91/149) vs. 25.3% (82/324), p < 0.001], drug withdrawal [28.6% (43/149) vs. 9.3% (30/324), p < 0.001], delayed biologics infusions [60.4% (90/149) vs. 19.1% (62/324), p < 0.001], and postponed elective surgery [16.1% (24/149) vs. 3.7% (12/324), p < 0.001]. There was an increased use of telemedicine after the outbreak compared to before the outbreak in Hubei province [38.9% (58/149) vs. 15.4% (23/149), p < 0.001], while such a significant increase was not observed in Guangdong province [21.9% (71/324) vs. 18.8% (61/324), p = 0.38]. Approximately two-thirds of IBD patients from both sites agreed that telemedicine should be increasingly used in future medical care.Conclusions: Our patient-based survey study in a real-world setting showed that COVID-19 resulted in a great impact on the healthcare of patients with IBD, and such an impact was more obvious in the epicenter compared to the non-epicenter area of COVID-19. Telemedicine offers a good solution to counteract the challenges in an unprecedented situation such as COVID-19.

At the Epicenter of COVID-19-the Tragic Failure of the Global Supply Chain for Medical Supplies.

The tragic failure of the global supply chain in the face of the current coronavirus outbreak has caused acute shortages of essential frontline medical devices and personal protective equipment, crushing fear among frontline health workers and causing fundamental concerns about the sustainability of the health system. Much more coordination, integration, and management of global supply chains will be needed to mitigate the impact of the pandemics. This article describes the pressing need to revisit the governance and resilience of the supply chains that amplified the crisis at pandemic scale. We propose a model that profiles critical stockpiles and improves production efficiency through new technologies such as advanced analytics and blockchain. A new governance system that supports intervention by public-health authorities during critical emergencies is central to our recommendation, both in the face of the current crisis and to be better prepared for potential future crises. These reinforcements offer the potential to minimize the compromise of our healthcare workers and health systems due to infection exposure and build capacity toward preparedness and action for a future outbreak.

Physical mobility under stay-at-home orders: A comparative analysis of movement restrictions between the U.S. and Europe

During the COVID-19 pandemic, both the U.S. and Europe have issued movement restrictions with the exception of visits to essential services, including groceries and pharmacies. Using Google's data on community mobility, I employ an event-study design to compare the effects of movement restrictions on physical mobility in the U.S. and Europe. I find that compared to Europe, the U.S. has higher levels of mobility related to visits to groceries and pharmacies and lower levels of the residential presence relative to baseline values, and the differences are not only statistically significant but also of large magnitudes. Such differences in post-restriction mobility are still significant between Europe and the U.S.’ early epicenters of COVID-19. The main results of this paper are robust to changes in samples and specifications. These findings suggest that movement restrictions appear to be less effective in the U.S., which have useful implications for health policy evaluation, pandemic forecasting, and economic recovery.

“Do You Deliver?” Teaching a Culinary Arts Internship Course in Brooklyn as New York City Became the COVID-19 Epicenter

Goldberg shares his experience of teaching a culinary arts internship course in Brooklyn as New York City became the COVID-19 epicenter His students earn an Associate of Applied Science Degree in Culinary Arts through the Tourism and Hospitality Department Classes meet weekly over a twelve-week semester Just before students graduate, they take a capstone course called CA-92 Internship in Culinary Arts With the help of the instructor, the students are responsible for arranging the course themselves The class is designed as a hybrid -- working together online for nine of the twelve weeks and meet in person only three times This allows the students more freedom to schedule their internship as they are also taking other classes Also, the purpose of the course is possibly self-explanatory to those in the industry, but since the students have less contextual knowledge their work is outlined in the syllabus Although the virus was being discussed among students and faculty, there were no official announcements that classes will be moved to online

Managements of 13 emergency cardiac surgeries under COVID-19 pandemic in a Sentinel Hospital.

BackgroundThe pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) creates many challenges for the healthcare sector. Currently, little is known of how the pandemic has impacted patients with cardiovascular disease. The primary focus of this study was to determine whether emergency cardiovascular surgeries can be carried out safely during the COVID-19 pandemic.MethodsBetween 17 January 2020 and 11 February 2020, 13 patients were admitted to Wuhan Union Hospital for emergency cardiovascular surgery. During this time, Wuhan was a COVID-19 epicenter, and Wuhan Union Hospital is a sentinel hospital located in this area. These patients’ epidemiological histories, clinical records, laboratory assessments, imaging findings, and surgical outcomes were retrospectively reviewed. Throat swabs were collected from some patients preoperatively and all patients postoperatively for reverse transcription polymerase chain reaction (RT-PCR) testing to determine whether these patients had COVID-19.ResultsThis cohort included 5 cases of acute aortic dissection, 3 cases of congenital heart disease, 2 cases of dilated cardiomyopathy with end-stage heart failure, 1 case of aortocoronary fistula that had undergone previous surgery, 1 case of subacute infective endocarditis with cerebral infarction, and 1 case of multivessel coronary disease. Six patients were suspected COVID-19 cases (46.2%). There were no confirmed COVID-19 cases in this cohort. None of the patients in this cohort died and none developed severe acute respiratory syndrome, renal failure, or septic shock after surgery. No cross-infection occurred with other patients or medical staff who came into close contact with this cohort.ConclusionsEmergency surgery is crucial and unavoidable for many patients with acute and severe cardiovascular disease, regardless of the pandemic. Our study indicates that, with adequate preparation and the provision of appropriate treatment, satisfactory outcomes can be achieved for such patients.

Clinical Spectrum of Sickle Cell Disease and COVID-19: Laboratory and Clinical Factors Associated with Morbidity and Mortality

Background: The COVID-19 pandemic has generated concern as a potential remarkably severe threat to the sickle cell disease (SCD) population. We aim to identify predictors of outcomes and survival in a large US-based SCD and COVID-19 cohort to inform best approaches to prevention and care.Methods: Clinical data were collected at baseline and during the clinical course using a standardized form in SCD patients diagnosed with COVID-19 at 5 academic centers in four COVID-19 epicenters. Patients were followed post-hospital discharge for up to 3 months.Results: Of 66 consecutive SCD patients with COVID-19, 75% required hospitalization, with a median length of stay of 6 days, and 7 died (10.6%). Patients with preexisting kidney disease were more likely to be hospitalized, while age, sex and genotype had no effect. The most common presenting symptom was vaso-occlusive pain. Chest X-ray was abnormal (acute chest syndrome) at presentation in 30 of 50 (61%) hospitalized and all deceased patients. Older age (median of 53 versus 32 years) and histories of pulmonary hypertension, congestive heart failure and/or stroke were more prevalent in deceased patients, as were high creatinine, lactate dehydrogenase, C-reactive protein, and D-dimers. The use of anti-coagulation, but not hydroxychloroquine or transfusion, during inpatient hospitalization was associated with decreased mortality (pConclusions: Patients with SCD and COVID-19 infection demonstrated a broad range of disease severity, from mild to very severe. COVID-19 in SCD individuals with pre-existing cardiopulmonary, renal disease and/or stroke presenting with pain and high creatinine should be considered at risk of death, irrespective of genotype or gender. Inpatient use of anticoagulation should be considered for all SCD patients with COVID-19. Though older individuals with vasculopathic comorbidities and high D-dimers were more likely to die, the median age of death was decades lower than the non-SCD population.Funding Statement: None.Declaration of Interests: NoneEthics Approval Statement: Each respective Institutional Review Board approved data collection as minimal-risk research and waived the requirement for informed consent.

COVID-19 in a Veterans Affairs Hospital at Suffolk County, Long Island, New York

COVID-19 in a Veterans Affairs Hospital at Suffolk County, Long Island, New York

Presenting Symptoms and Predictors of Poor Outcomes Among 2,184 Patients with COVID-19 in Lagos State, Nigeria

IntroductionLagos state remains the epicentre of COVID-19 in Nigeria. We describe the symptoms and signs of the first 2,184 PCR-confirmed COVID-19 patients admitted at COVID-19 treatment centers in Lagos State. We also assessed the relationship between patients’ presenting symptoms, sociodemographic and clinical characteristics and COVID-19 deaths.. MethodsMedical records of PCR-confirmed COVID-19 patients were extracted and analyzed for their symptoms, symptom severity, presence of comorbidities and outcome. ResultsThe ages of the patients ranged from 4 days to 98 years with a mean of 43.0(16.0) years. Of the patients who presented with symptoms, cough (19.3%) was the most common presenting symptom. This was followed by fever (13.7%) and difficulty in breathing, (10.9%). The most significant clinical predictor of death was the severity of symptoms and signs at presentation. Difficulty in breathing was the most significant symptom predictor of COVID-19 death (OR:19.26 95% CI 10.95-33.88). The case fatality rate was 4.3%. ConclusionPrimary care physicians and COVID-19 frontline workers should maintain a high index of suspicion and prioritize the care of patients presenting with these symptoms. Community members should be educated on such predictors and ensure that patients with these symptoms seek care early to reduce the risk of deaths associated with COVID-19.

Depression and Anxiety During the COVID-19 Pandemic in an Urban, Low-Income Public University Sample.

Mental health disparities in the aftermath of national disasters and the protective role of socioeconomic status are both well documented. We assessed the prevalence of depression and anxiety symptoms among underresourced public university students during the COVID‐19 pandemic in New York City. Between April 8, 2020, and May 2, 2020, adult students (N = 1,821) across the CUNY system completed an online survey examining COVID‐19–related stressors and mental health and sociodemographic factors. Using multivariable logistical regression to assess the association between COVID‐19–related stressors and depression and anxiety symptoms, we found a high prevalence and severity of depression and anxiety symptoms. We also observed that more exposure to COVID‐19–related stressors was associated with increased depressive (27.0%, 41.4%, and 63.1% for low‐, medium‐, and high‐level stressors, respectively) and anxiety symptoms (19.3%, 34.6%, 52.2%). In addition, the degree of exposure to COVID‐19–related stressors served as an important predictor of depression and anxiety symptoms. Compared to high levels of stressors, the odds of depression were 0.2, 95% CI [0.2, 0.3] for low‐ and 0.4, 95% CI [0.3, 0.5] for medium‐level stressors; for anxiety, the odds were 0.2, 95% CI [0.2, 0.3] for low and 0.05, 95% CI [0.4, 0.6] for medium stressors. Finally, household savings of less than $5,000 increased the risk of anxiety but not depression symptoms, OR = 1.3, 95% CI [1.0,1.6]. Together, these findings tell a devastating story of psychological distress among students from lower socioeconomic groups living in the COVID‐19 epicenter of the U.S. pandemic.

Online support information for students with disabilities in colleges and universities during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic necessitated a rapid shift to remote instruction. This may have caused particular challenges for students with disabilities. ObjectiveWe aimed to describe the availability of remote instruction and counseling resources on the disability/accessibility websites of colleges and universities in the greater New York City area. At the time this study was conducted, this region was the global COVID-19 epicenter. MethodsAll colleges/universities in the New York City metropolitan area were identified using Petersen’s online search guide. Descriptive information (institution’s name, size, and location) was recorded. The disability/accessibility pages of websites were located and examined for remote instructional resources for both educators and for students, a way to make an appointment with the counseling center (phone number and/or email address), and a link to the counseling center. Descriptive statistics were recorded (percentages of small, medium, large size institutions, mean, median, range and standard deviations of enrollments, and number and percentage of institutions that provided online accessibility resources) and one-sided Chi square tests were conducted to test the relationship between school size and the availability of resources. Results17% of the colleges/universities had no link to disability/accessibility services on their websites. Of the remaining 127 institutions, few made the aforementioned resources available on the disability/accessibility page. The most prevalent resource observed was providing students with remote instruction assistance. The association between school size and the aforementioned resources was not statistically significant. ConclusionMaking information available to students with disabilities is a fundamental part of accessibility in higher education. Doing so is all the more necessary given the challenges wrought by the COVID-19 pandemic, challenges which are likely to continue for years to come.