Epicenter Of Pandemic Research Articles

Should everyone in need be treated equally? A European survey of expert judgment on social vulnerability to floods and pandemics to validate multi-hazard vulnerability factors

Several European countries were affected by severe floods in 2021. At the same time, despite the deployment of vaccines, Europe was the COVID-19 pandemic's epicenter several times during 2021. One research aim of this study is to identify socio-demographic groups vulnerable to floods and whether the groups vulnerable to floods and pandemics overlap or are disjoint. We ran a survey in four languages (English, French, German, and Spanish) and collected the judgment of 366 experts in disaster risk management and first-responders to find out how those people caring for “people in need” (be it operational or administratively) think about which persons are more at risk than others. Another research aim is to validate multi-hazard vulnerability factors by comparing judgment on groups vulnerable to the COVID-19 pandemic and to floods. The main findings are that experts think that socially vulnerable groups should be rescued or treated first. Treating everyone equally is less favored by comparison. Infrastructure losses, followed by economic losses, reveal better than deaths or psychological issues whether vulnerability played a role in a disaster. Regarding vulnerability characteristics, older, homeless people, and immigrants rank highest, and most factors can be used to explain both flood and COVID-19 vulnerability, while some differ; for example, mobility impairment is less important for COVID-19. There are major discrepancies between what respondents think should be done to prioritize help to certain groups and what they have experienced is being done on the field.

Prevalência e fatores associados à COVID longa em adultos do Sul do Brasil: achados da coorte PAMPA

Abstract: Most COVID-19 survivors have reported experiencing persistent symptoms after the infection - these types of cases are known as long COVID. Since Brazil was an epicenter of the COVID-19 pandemic, a high burden of long COVID is expected. This study aimed to identify the prevalence and factors associated with long COVID in adults in Southern Brazil, analyzing data from the PAMPA cohort. Participants filled out a self-reported online questionnaire in June 2022. This study only included subjects who tested positive for COVID-19. Long COVID was defined by any symptoms that persisted for at least three months after the SARS-CoV-2 infection. Poisson’s regression models with robust variance were used to identify factors associated with long COVID; and results were reported as prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 1,001 participants (77.4% women, mean age [SD] = 38.3 [11.9] years) were analyzed. The prevalence of long COVID among these patients was 77.4% (95%CI: 74.7; 79.9). The likelihood of long COVID was higher in unvaccinated participants (PR = 1.23, 95%CI: 1.06; 1.42), in those with chronic conditions (PR = 1.13, 95%CI: 1.04; 1.24), and in those who were hospitalized due to the COVID-19 infection (PR = 1.24, 95%CI: 1.16; 1.32). This prevalence was also higher in women (PR = 1.21, 95%CI: 1.09; 1.33) than in men. Physical activity was associated with a reduced likelihood of fatigue, neurological complications, coughing, and headaches as persistent symptoms after a COVID-19 infection. It was found that three out of four adults in Southern Brazil experienced long COVID. Public policies aiming to reduce the burden of long COVID must be prioritized, especially in groups that are at higher risk of developing this harmful condition.

The Early Emotional Responses and Central Issues of People in the Epicenter of the COVID-19 Pandemic: An Analysis from Twitter Text Mining

This study aimed to explore citizens’ emotional responses and issues of interest in the context of the coronavirus disease 2019 (COVID-19) pandemic. The dataset comprised 65,313 tweets with the location marked as New York State. The data collection period was four days of tweets when New York City imposed a lockdown order due to an increase in confirmed cases. Data analysis was performed using R Studio. The emotional responses in tweets were analyzed using the Bing and NRC (National Research Council Canada) dictionaries. The tweets’ central issue was identified by Text Network Analysis. When tweets were classified as either positive or negative, the negative sentiment was higher. Using the NRC dictionary, eight emotional classifications were devised: “trust,” “fear,” “anticipation,” “sadness,” “anger,” “joy,” “surprise,” and “disgust.” These results indicated that citizens showed negative and trusting emotional reactions in the early days of the pandemic. Moreover, citizens showed a strong interest in overcoming and coping with other people such as social solidarity. Citizens were concerned about the confirmation of COVID-19 infection status and death. Efforts should be made to ensure citizens’ psychological stability by promptly informing them of the status of infectious disease management and the route of infection.

Emergency Medicine Residents' Perceptions of Working and Training in a Pandemic Epicenter: A Qualitative Analysis.

We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York. A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey. Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators. Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.

Racial Differences and Injury Pattern Variation: Impact of COVID-19 on a Bronx Trauma Center.

New York City (NYC) became the epicenter of the COVID-19 pandemic in 2020. The Bronx, with the highest rates of poverty and violent crime of all NYC boroughs and a large Black and Hispanic population, was at increased risk of COVID-19 and its sequelae. We aimed to identify temporal associations among COVID-19 and trauma admission volume, demographics, and mechanism of injury (MOI). A retrospective review of prospectively collected data was conducted from a Level II trauma center in the Bronx. January 1st-September 30th for both 2019 (Pre-COVID) and 2020 (COVID) were compared. Pre-COVID and COVID cohorts were subdivided into EARLY (March-May) and LATE (June-September) subgroups. Demographics and trauma outcomes were compared. Trauma admissions were similar between Pre-COVID and COVID. During COVID, there was an increased percentage of Black patients (Black Hispanic 20.1% vs 15.2% and Black Non-Hispanic 39.4% vs 34.1%, P < .05), younger patients (26-35years old: 22.6% vs 17.6%, P < .05), and out-of-pocket payors (6.0% vs 1.6%, P < .05). Trauma severity outcomes were mixed-some measures supported increased severity; others showed no difference or decreased severity. During COVID, there was a rise in total penetrating injuries (27.4% vs 20.8%, P < .05), MVC (13.2% vs 7.1, P < .05), and firearm injuries (11.6% vs 6.0%, P < .05). Additionally, during LATE COVID, there was a resurgence of total penetrating, total blunt, MVC, falls, cyclists/pedestrians struck, and firearm injuries. Our results emphasize MOI variations and racial differences of trauma admissions to a Level II trauma center in the Bronx during COVID-19. These findings may help trauma centers plan during pandemics and encourage outreach between trauma centers and community level organizations following future healthcare disasters.

The Implications of COVID-19 Infection on Hematologic Parameters and Coagulation Activity: A Review

Wuhan, China, substantially is the epicenter of the COVID-19 pandemic in December 2019. Coronavirus, the confounder virus, a zoonotic in origin was the causative agent of the disseminated disease worldwide. Structural similarities and convergence points were demonstrated between the coronavirus, SARS, and MERS viruses. Aberrantly, a subset of patients developed a serious acute respiratory distress syndrome or diffuse alveolar injury whereas the rest of the patients encountered mild or no symptoms. The pathological clinical laboratory findings are not only critical in the diagnosis of the COVID-19 infection, on the contrary, but they are also crucial in the prognostic predictions about disease prognosis and therapeutic response. This review aims to give some historical context for the pandemic, demonstrate the laboratory's important role in the screening of COVID-19 infection, and review the current phase of biomarker examination in COVID-19 infection, focusing on markers derived directly from the hematological laboratory, reflecting the implications of COVID-19 on the hematological system and coagulation pathways. In conclusion, there is a direct significant correlation between infection severity, the death rate in COVID-19 patients, and the low number of either WBCs or a high number of WBCs with a low number of lymphocytes.

Rethinking Surge Preparedness After COVID-19: Effective Patient Load Balancing Within Health Systems and Beyond.

Within weeks of New York State's first confirmed case of COVID-19, New York City became the epicenter of the nation's COVID-19 pandemic. With more than 80,000 COVID-19 hospitalizations during the first wave alone, hospitals in downstate New York were forced to adapt existing procedures to manage the surge and care for patients facing a novel disease. Given the unprecedented surge, effective patient load balancing-moving patients from a hospital with diminishing capacity to another hospital within the same health system with relatively greater capacity-became chief among the capabilities required of New York health systems. The Greater New York Hospital Association invited members of downstate New York's 6 largest health systems to talk about how each of their systems evolved their patient load balancing procedures throughout the pandemic. Informed by their insights, experiences, lessons learned, and collaboration, we collectively present a set of consensus recommendations and best practices for patient load balancing at the facility and health system level, which may inform regional approaches to patient load balancing.

The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines

The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines

Detection of COVID-19 pulmonary manifestations with radiotherapy simulation CT imaging

COVID-19 is associated with characteristic lung CT findings. Radiotherapy simulation CT scans may reveal characteristic COVID-19 findings and identify patients with active or prior infection. We reviewed patients undergoing CT simulation at a major cancer center in an early epicenter of the COVID-19 pandemic in the United States. Scans were reviewed by radiation oncologists using established radiographic criteria for COVID-19 pneumonia. Radiographic classifications were compared with available COVID-19 PCR test results. A one-tailed t-test was used to compare the rate of positive COVID-19 tests in radiographically suspicious vs. non-suspicious groups. Scans deemed suspicious were re-reviewed by expert diagnostic radiologists. 414 CT simulation scans were performed on 400 patients. 119 patients had COVID-19 PCR test results available. Radiation oncologists considered 71 scans (17.1%) suspicious for COVID-19. Of these, 23 had corresponding COVID-19 PCR tests, and 3/23 (15.7%) were positive for COVID. 107 non-suspicious scans had corresponding COVID-19 test results, and 9 were positive (8.4%). The difference in positive test results between suspicious and non-suspicious groups was not significant (p = 0.23). Upon re-review by a diagnostic radiologist, 25 (35%) scans deemed suspicious by radiation oncologists were confirmed to meet criteria, while the rest were re-classified as “atypical” for COVID-19. We conclude that radiotherapy simulation CT scans can be reviewed for signs of COVID-19 pneumonia by radiation oncologists. However, suspicious CT simulation was not associated with a higher incidence of COVID infection compared with non-suspicious CT simulation, and there was low concordance between radiation oncologist and diagnostic radiologist classification of scans.

Increasing availability of COVID-19 vaccine to older adults under community supervision

PurposeVaccinating adults who are involved with the carceral system, particularly those aged 55 or older, is crucial to containing the COVID-19 pandemic in the USA, particularly as variants continue to emerge and spread. In this Viewpoint, the authors discuss the reasons why improving access to COVID-19 vaccine and boosters among community supervised adults, especially the aging population, is critical to mitigating the public health consequences of the COVID-19 pandemic. This study concludes by providing recommendations to enhance vaccine and booster uptake in this population, as the pandemic continues.Design/methodology/approachThis is a Viewpoint paper regarding mitigating the spread of COVID-19 by improving access to vaccine and boosters among community supervised adults, especially the aging population.FindingsA key population that has been overlooked in vaccination efforts are older adults involved in the carceral system who are living in the community (i.e. “community supervised” or people on probation or parole). Older adults on probation and parole are at high risk for SARS-CoV-2 transmission and severe disease due to numerous factors at the individual, community, social and structural levels.Originality/valueImplementation of recommendations presented in this Viewpoint will mitigate COVID-19 risk among a population that has been marginalized and overlooked, yet has been the epicenter of the COVID-19 pandemic.

Impact of Covid-19 on rates of gestational diabetes in a North American pandemic epicenter.

We assessed the impact of Covid-19 on gestational diabetes rates in Quebec, the pandemic epicenter of Canada. We conducted a population-based study of 569,686 deliveries in Quebec between 2014 and 2021. We measured gestational diabetes rates in wave 1 (March 1, 2020-August 22, 2020) and wave 2 (August 23, 2020-March 31, 2021), compared with the prepandemic period. We used interrupted time series regression to assess changes in gestational diabetes rates during each wave, and log-binomial regression models to estimate adjusted risk ratios (RR) and 95% confidence intervals (CI) for the association of the pandemic with gestational diabetes. We identified the types of patients that contributed to the change in gestational diabetes rates using Kitagawa's decomposition. Gestational diabetes rates were higher during the first (13.2 per 100 deliveries) and second waves (14.3 per 100 deliveries) than during the prepandemic period (12.4 per 100 deliveries). Risk of gestational diabetes increased both in wave 1 (RR 1.05, 95% CI 1.02-1.09) and wave 2 (RR 1.14, 95% CI 1.10-1.18), compared with the prepandemic period. However, most of the increase in gestational diabetes rates was driven by low-risk women without Covid-19 infections who were socioeconomically advantaged, had no comorbidity, and were 25-34years of age. Gestational diabetes rates increased during the pandemic, mainly among women traditionally at low risk of hyperglycemia who did not have Covid-19 infections. Sudden widespread changes in screening or lifestyle can have a large impact on gestational diabetes rates in a population.

The Early 2020 COVID-19 Outbreak in China and Subsequent Flourishing: Medium-Term Effects and Intervening Mechanisms.

In early 2020, a COVID-19 outbreak occurred in Hubei Province of China. Exploiting the geographic concentration of China's COVID-19 cases in Hubei (the initial epicenter), we compare Hubei and non-Hubei residents to examine the medium-term effect of exposure to the COVID-19 outbreak on mental well-being. We examine flourishing-a comprehensive assessment of well-being that is not merely the absence of mental illness-and investigate a broad set of psychosocial and economic mediators that may link initial outbreak exposure to subsequent flourishing. We use ordinary least squares regression models to analyze national panel data collected in early 2020 and late 2021 (N = 3,169). Results show that flourishing scores remain lower for Hubei than non-Hubei residents almost two years following the early 2020 COVID-19 outbreak. Mediation analysis reveals that Hubei residents' lower incidences of job promotion and lower sense of control are the two most important mediators accounting for their lower flourishing relative to non-Hubei residents. Combined, this study provides the first evidence of the medium-term psychological vulnerability borne by individuals who lived in the initial epicenter of the COVID-19 pandemic. Findings on the intervening mechanisms shed light on the policy initiatives needed for post-pandemic mental well-being recovery in China and other countries.

The feasibility of SARS-CoV-2 surveillance using wastewater and environmental sampling in Indonesia.

Wastewater-based epidemiology (WBE) surveillance as an early warning system (EWS) for monitoring community transmission of SARS-CoV-2 in low- and middle-income country (LMIC) settings, where diagnostic testing capacity is limited, needs further exploration. We explored the feasibility to conduct a WBE surveillance in Indonesia, one of the global epicenters of the COVID-19 pandemic in the middle of 2021, with the fourth largest population in the world where sewer and non-sewered sewage systems are implemented. The feasibility and resource capacity to collect samples on a weekly or fortnightly basis with grab and/or passive sampling methods, as well as to conduct qualitative and quantitative identification of SARS-CoV-2 ribonucleic acid (RNA) using real-time RT-PCR (RT-qPCR) testing of environmental samples were explored. We initiated a routine surveillance of wastewater and environmental sampling at three predetermined districts in Special Region of Yogyakarta Province. Water samples were collected from central and community wastewater treatment plants (WWTPs), including manholes flowing to the central WWTP, and additional soil samples were collected for the near source tracking (NST) locations (i.e., public spaces where people congregate). We began collecting samples in the Delta wave of the COVID-19 pandemic in Indonesia in July 2021. From a 10-week period, 54% (296/544) of wastewater and environmental samples were positive for SARS-CoV-2 RNA. The sample positivity rate decreased in proportion with the reported incidence of COVID-19 clinical cases in the community. The highest positivity rate of 77% in week 1, was obtained for samples collected in July 2021 and decreased to 25% in week 10 by the end of September 2021. A WBE surveillance system for SARS-CoV-2 in Indonesia is feasible to monitor the community burden of infections. Future studies testing the potential of WBE and EWS for signaling early outbreaks of SARS-CoV-2 transmissions in this setting are required.

COVID-19 pandemic and minority health disparities in New York City: A spatial and temporal perspective.

New York City (NYC) was the epicenter of COVID-19 pandemic for a long time, and the government introduced a city-wide lockdown policy to mitigate the spread of virus. Minority communities, however, suffered disproportionally high percentage of infection and mortality rates, a disturbing phenomenon that deserves scrutiny. Adopting a spatial and temporal perspective, this study aims to investigate health disparities in this pandemic by focusing on mobility in the city. Considering both public transit and the lockdown policy essential factors that impact infection and mortality, this study introduced a measure indicating mobility-restricted transit as the spatial factor. Additional factors include ethnic minorities based on their nativity and three categories of social vulnerability: socioeconomic status, household composition, and housing type. This study selects eight phases, each of which consists of 2 weeks to derive infection and mortality rates to investigate the impacts of those factors. As infection and mortality data are published based on ZIP code, this study further estimates the infection and mortality rates at a finer level of census tract through spatial apportionment. Results reveal the significant impact of mobility-restricted transit on both infection and mortality and show certain clusters of neighborhoods being highly impacted. In addition, this study identifies neighborhoods where native-born and foreign-born of each ethnic minority (Blacks, Hispanics, and Asians) have high risk of infection and mortality. Through a spatial and temporal perspectives, this study identifies the complexity of patterns in minority health disparities in COVID-19 pandemic, which can inform policy makers for localized support to vulnerable neighborhoods to alleviate minority health disparities.

Assessing the effectiveness of quarantine measures during the COVID-19 pandemic in Chile using Bayesian structural time series models.

BackgroundWith the emergence of the COVID-19 pandemic, all existing health protocols were tested under the worst health crisis humanity has experienced since the Black Death in the 14th century. Countries in Latin America have been the epicenter of the COVID-19 pandemic, with more than 1.5 million people killed. Worldwide health measures have included quarantines, border closures, social distancing, and mask use, among others. In particular, Chile implemented total or partial quarantine measures depending on the number of infections in each region of the country. Therefore, it is necessary to study the effectiveness of these quarantines in relation to the public health measures implemented by government entities at the national level.ObjectiveThe main objective of this study is to analyze the effectiveness of national- and region-level quarantines in Chile during the pandemic based on information published by the Chilean Ministry of Health, and answers to the following question are sought: Were quarantine measures in Chile effective during the COVID-19 pandemic?MethodsThe causal effect between the rates of COVID-19 infections and the population rates in Phase 1 and Phase 2 quarantines in the period from March 2020 to March 2021 in different regions of Chile were evaluated using intervention analyses obtained through Bayesian structural time series models. In addition, the Kendall correlation coefficient obtained through the copula approach was used to evaluate the comovement between these rates.ResultsIn 75% of the Chilean regions under study (12 regions out of a total of 16), an effective Phase 1 quarantine, which was implemented to control and reduce the number of cases of COVID-19 infection, was observed. The main regions that experienced a decrease in cases were those located in the north and center of Chile. Regarding Phase 2, the COVID-19 pandemic was effectively managed in 31% (5 out of 16) of the regions. In the south-central and extreme southern regions of Chile, the effectiveness of these phases was null.ConclusionThe findings indicate that in the northern and central regions of Chile, the Phase 1 quarantine application period was an effective strategy to prevent an increase in COVID-19 infections. The same observation was made with respect to Phase 2, which was effective in five regions of northern Chile; in the rest of the regions, the effectiveness of these phases was weak or null.

Lessons from the Epicenter of the COVID-19 Pandemic: An Analysis of the Surgical Completion Rates between Priority Classes and Procedure Types.

In March of 2020, elective surgical procedures in New York State were suspended in response to the COVID-19 pandemic. At Northwell Health, this lasted a total of 8 weeks, leaving plastic surgeons responsible for recording and rescheduling delayed procedures. Many plastic and reconstructive procedures are considered elective, but these procedures can be time sensitive, and delays can have a negative impact on patient care.1 Our goal was to compare the rates of completion and time to completion between different priority groups and procedure types in order to predict potential consequences for one’s practice if future suspensions in elective surgery were to occur. We hypothesized that procedures grouped in the reconstructive categories with higher priority levels would have a higher completion rate and lower time to completion compared to less urgent, aesthetic based procedures. Plastic surgeons working for our department were responsible for keeping track of their suspended cases between March 23, 2020, and May 19, 2020.2,3 Under the discretion of the attending plastic surgeon, cases were categorized into procedure type, priority level, and surgery setting. The procedure types included aesthetic, pediatrics/craniofacial, hand, general, and reconstructive. The priority classes were elective, nonurgent, semiurgent, urgent, and emergent. The surgery setting was classified into inpatient and outpatient. In total, we examined 135 surgical cases that were suspended (Table 1). The average patient age was 45.8 years, and 45.9 percent of the surgical procedures were completed by the end of August of 2020, more than 3 months after the suspension was lifted. Of those that were completed, the average time to completion from the original surgical date was 79.2 days. Surgery classifications are summarized in Table 1. We ran binary logistic regressions that showed no significant correlation between the surgery type, urgency, or priority class and whether or not the surgery was completed. In addition, linear regression analyses did not show a significant correlation between the surgery type, urgency, or priority class and the time it took to complete the surgery. All the models controlled for patient age and whether or not there was malignancy. Table 1. - Summary of Sample by Procedure Priority Procedure Classification No. of Patients Percent of Sample Priority Elective 8 5.93% Nonurgent 80 52.29% Semiurgent 22 16.30% Urgent 24 17.78% Emergent 1 0.01% Type Aesthetic 12 8.89% Pediatrics/craniofacial 10 7.41% Hand 9 6.67% General 35 25.93% Reconstructive 68 50.37% No type specified 1 0.74% Location Inpatient 34 25.19% Outpatient 66 48.89% No location specified 35 25.93% Our surprising results may be due to several factors, including differences in patients’ concerns with undergoing surgery during a pandemic, patients’ continuous desire to undergo aesthetic surgery, or a lack of prioritization of urgent cases when rescheduling surgery. With new variants of SARS-CoV-2 emerging and the number of COVID-19 cases climbing rapidly in the United States,5 plastic surgeons must be prepared for another potential suspension of surgery.6 Plastic surgery departments and private practices can use our experience to guide their recovery from future surgical suspension. Prior studies have already shown the tremendous economic impact of surgery delays on plastic surgeons.4Additional research is needed, however, to evaluate the impact of delays on patient care and quality of life. A more systematic approach to rescheduling surgery, which prioritizes the most vulnerable patients, is needed. DISCLOSURE The authors have no relevant financial disclosures to report.

Associations between depressive symptoms and quality of life among residents of Wuhan, China during the later stage of the COVID-19 pandemic: A network analysis

BackgroundVarious populations have experienced significant increases in depression and decreased quality of life (QOL) during the coronavirus disease 2019 (COVID-19) pandemic. This network analysis study was designed to elucidate interconnections between particular depressive symptoms and different aspects of QOL and identify the most clinically important symptoms in this network among adults in Wuhan China, the initial epicenter of the COVID-19 pandemic. MethodsThis cross-sectional, convenience-sampling study (N = 2459) was conducted between May 25 to June 18, 2020, after the lockdown policy had been lifted in Wuhan. Depressive symptoms and QOL were measured with the Patient Health Questionnaire-9 (PHQ-9) and first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. A network structure was constructed from the extended Bayesian Information Criterion (EBIC) model. Network centrality strength and bridge strength were evaluated along with the stability of the derived network model. ResultsLoss of energy (DEP-4) and Guilt feelings (DEP-6) were the two central symptoms with the highest strength as well as the two most prominent bridge symptoms connecting the clusters of depression and quality of life (QOL) in tandem with the two nodes from the QOL cluster. Network structure and bridge strengths remained stable after randomly dropping 75 % of the sample. ConclusionInterventions targeting “Loss of energy” and “Guilt feelings” should be evaluated as strategies for reducing depressive symptoms and promoting improved QOL in COVID-19-affected populations.

Tracheostomy Thursday: Journey of a Staff-driven COVID-19 Initiative to International Recognition.

To use evidence-based practice and an interprofessional approach to improve outcomes for adult patients with tracheostomies and enhance staff knowledge during the COVID-19 pandemic. The core interprofessional Tracheostomy Thursday team included staff nurses, respiratory therapists, and nursing leadership who collaborated with surgeons and materials management staff at an urban academic medical center in New York, the epicenter of the COVID-19 pandemic in the US. The team implemented hospital-wide bedside rounds on all adults with tracheostomies. Skin and safety assessments were performed with peer-to-peer coaching. Data were collected and analyzed to understand areas of improvement. After 6 months of hospital-wide rounding, implementation of a bedside tracheostomy safety checklist, and a continued interprofessional approach, safety measures increased by 48%, and preventive dressing use increased by 24% with improvement in preventing tracheostomy-related medical device-related pressure injuries. The team's work was professionally recognized through institutional policy change, conference poster presentations, and Sigma's international excellence award. Bundling an interprofessional approach, staff education, bedside rounds, and standard preventive measures was key to the team's success. A bedside safety checklist fostered team communication and supported direct care nurses in managing individuals with a new tracheostomy.

Adolescence and COVID-19: Traumatic Stress and Social Distancing in the Italian Epicenter of Pandemic

The spread of the COVID-19 Pandemic led the Italian government to impose restrictive measures. Schools were closed and the organization of Distance Learning (DL) made adolescents face the psychological impact of the pandemic and the loss of their social life. This research aimed to evaluate the psychological impact of the COVID-19 Pandemic and DL on students, attending two high schools in the Lodi area (Lombardy, Italy). A questionnaire, composed of PSYCHO-COVID 19 and EMOTION THERMOMETER applied to DL, was administered anonymously through the Google Drive School platform, from May 5th to June 5th 2020. Analysis of the protocols revealed stress reactions in 35% of students (12% High, 7% Moderate, 16% Mild). Principal Components Analysis also revealed the presence of a "distress entity" characterized by anxiety, depressive and somatic symptoms (comparable to those of post-traumatic stress syndrome), with a greater impact on females. The analysis of data on DL showed that online teaching was experienced negatively, in an almost linear correlation, by those subjects who had expressed distress. The results suggest that the pandemic had a traumatic impact on adolescents, especially on girls; psychological distress negatively influenced individual experiences with DL. Appropriate psychotherapeutic interventions are needed to prevent the chronicization of stress reactions and to facilitate the adaptation of adolescents to possible rapid changes in educational management.

The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic.

Understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in 2019 is critical to preventing zoonotic outbreaks before they become the next pandemic. The Huanan Seafood Wholesale Market in Wuhan, China, was identified as a likely source of cases in early reports but later this conclusion became controversial. We show the earliest known COVID-19 cases from December 2019, including those without reported direct links, were geographically centered on this market. We report that live SARS-CoV-2 susceptible mammals were sold at the market in late 2019 and, within the market, SARS-CoV-2-positive environmental samples were spatially associated with vendors selling live mammals. While there is insufficient evidence to define upstream events, and exact circumstances remain obscure, our analyses indicate that the emergence of SARS-CoV-2 occurred via the live wildlife trade in China, and show that the Huanan market was the epicenter of the COVID-19 pandemic.