Pandemic News Links / Current News Updates

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COVID Takes Challenge of Tracking Infectious College Students to New Level

10/12/20


https://khn.org/news/covid-contact-trac ... addresses/

As the return of college students to campuses has fueled as many as 3,000 COVID-19 cases a day, keeping track of them is a logistical nightmare for local health departments and colleges.

Some students are putting down their home addresses instead of their college ones on their COVID testing forms — slowing the transfer of case data and hampering contact tracing across state and county lines.

The address issue has real consequences, as any delay in getting the case to the appropriate authorities allows the coronavirus to continue to spread unchecked. Making matters worse, college-age people already tend to be hard to trace because they are unlikely to answer a phone call from an unknown number.

“With that virus, you really need to be able to identify that case and their contacts in 72 hours,” said Indiana University’s assistant director for public health, Graham McKeen.

And if the students do go home once infected, where should their cases be counted? The Centers for Disease Control and Prevention highlighted this issue in a recent study of an unnamed North Carolina university’s COVID outbreak, stating that the number of cases was likely an underestimate. “For example, some cases were reported to students’ home jurisdictions, some students did not identify themselves as students to the county health department, some students did not report to the student health clinic, and not all students were tested,” it said.

The White House Coronavirus Task Force even addressed the problem in weekly memos sent to the governors of Missouri, Arkansas, Iowa, Kentucky and New Jersey. “Do not reassign cases that test positive in university settings to hometown as this lessens ability to track and control local spread,” it recommended late last month in the memos, made public by the Center for Public Integrity.

While the full scope of the address confusion is unclear, the health departments of California, Indiana, Iowa and Virginia all acknowledged the challenges that arise when college cases cross state and county lines.

The maze of calls needed to track such cases also lays bare a larger problem: the lack of an interconnected COVID tracking system. Colleges have been setting up their own contact tracing centers to supplement overstretched local and state health departments.

“It is very patchwork, and people operate very differently, and it also doesn’t translate during a pandemic,” said McKeen, whose own university has had more than 2,900 cases across its Indiana campuses. “It made it very clear the public health system in this country is horribly underfunded and understaffed.”

Colleges’ transient populations have forever bedeviled public health when it comes to reportable infectious diseases, such as measles and bacterial meningitis, Association of Public Health Laboratories spokesperson Michelle Forman said in an email to KHN. But the coronavirus infections spreading across the country’s universities, and the mass testing conducted to find them, are something else altogether.

“COVID is just a different scale,” she said.

Lisa Cox, a spokesperson for the Missouri Department of Health and Senior Services, said the issue of transient addresses affects more than just college students. Jails and rehab facilities also have people moving in and out, exacerbating the risk of disease spread and the difficulty in tracking it.

The crush of student cases at the start of a new term, though, can be overwhelming. As students returned to the University of Missouri, the Columbia/Boone County Department of Public Health and Human Services saw a COVID spike, with the peak reaching more than 200 new cases per day.

“So, first of all, we’re delayed anyway because we can’t keep up with the onslaught of cases,” said Scott Clardy, assistant director of the health department.

But then, he added, these address mishaps required his department to spend time attempting to reclassify counts and contact possibly infected people.

“It slows us down,” he said, estimating the department was up to five days behind in mid-September on contacting infected people and reaching out to those who may have been exposed to the virus.

The University of Missouri has had more than 1,600 cases so far, but spokesperson Christian Basi said the number of new cases has dropped significantly. By the end of September, the health department had finally caught up, Clardy said, letting staffers trace contacts more quickly.

This address issue can also mean some cases are potentially being undercounted, double counted or initially counted incorrectly as state health departments sort out where these infected students actually are staying, Indiana University’s McKeen said — potentially skewing case counts and positivity rates for local jurisdictions. He has noticed several such cases.

Iowa and Indiana officials said they were working with localities to ensure cases did not go miscounted, including developing directions for college students to put down their school address. Virginia officials said their contact tracers work diligently to identify the infected person’s current location and share it with other health departments if it is out of Virginia.

In Massachusetts, Pat Bruchmann, chief public health nurse for the Worcester Division of Public Health, said she had noticed some students at the 11 colleges in her district were getting tested off campus or when they went home for the weekend. In response, her department now proactively looks for positive test results among people who are of typical college age. So far, she’s had 10 or so cases reassigned to her department from other areas because of address issues, Bruchmann said.

Back in Missouri, freshman Kate Taylor said she fell through the cracks amid the initial rush of cases at the University of Missouri at the end of August.

After testing positive for COVID-19, Taylor said, she was told there wasn’t enough room for her to quarantine on campus. The university’s Basi denied that any students had been told the school didn’t have enough space but said he could not discuss details of Taylor’s case without her consent.

The 18-year-old student said she went home 2½ hours away to Jefferson County, where she was told her case would be transferred to local officials. But after nine days of quarantining, Taylor said, she never heard from anyone at her local health department.

She said her contact tracing experience wasn’t much better: Her boyfriend at the university got a call about her case, but the tracer got him confused with her roommate. The tracer then hung up.
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People with pandemic-related stress show least engagement at work

10/12/20


https://www.news-medical.net/news/20201 ... -work.aspx

As COVID-19 cases surged this spring, the pandemic led some people more than others to ponder their own mortality. A new study in China and the United States suggests that these people were the ones who showed the highest levels of stress and the least engagement at work.

But the research also uncovered a bright spot: The right kind of boss helped reduce stress and increase engagement and pro-social behavior in their workers who were anxious about COVID-19.

"A global pandemic can lead some people to think about their own mortality, which will understandably make them more stressed and less engaged at work. But business leaders who are attentive to employees' emotional needs and unite them behind a common purpose made a positive difference and helped workers stay engaged at work and contribute to their communities."

-Jia (Jasmine) Hu, lead author of the study and associate professor of management and human resources at The Ohio State University's Fisher College of Business

The study was published online recently in the Journal of Applied Psychology.

The researchers conducted three studies.

One study involved 163 workers at an information technology company in eastern China who filled out surveys twice a day over three weeks while cases of COVID-19 were surging in the country.

Results showed that the more that the employees thought about COVID-19 related deaths, the more anxious they felt and the less engaged they were in their jobs.

But the employees' anxiety and engagement were influenced by the type of boss they had. Employees did better if their boss exhibited what is called "servant leadership." As the name implies, servant leaders prioritize fulfillment of others' needs, attend to employees' emotional suffering, work to empower employees, and emphasize serving the community.

Employees in the study rated on a scale of 1 to 7 how much "My supervisor makes my career development a priority" and other statements that measured servant leadership.

Those who rated their supervisors higher on servant leadership showed less anxiety and were more engaged with their jobs than other employees, Hu said.

"Servant leaders care about their employees' well-being and prioritize their personal growth and happiness at their jobs," she said.

"These types of leaders made it easier for their employees to deal with the anxiety associated with the pandemic."

But servant leaders did more than that: They helped their employees channel their stress into positive behaviors.

The findings showed that employees who rated their bosses as higher on servant leadership were more likely to report that they engaged in pro-social behavior, such as volunteering for a charitable group in their community.

"Servant leaders encouraged their employees to find meaning in the pandemic by channeling their anxiety into helping less fortunate people in their communities," Hu said.

These results were confirmed in two U.S. studies in which participants were told to imagine they were consultants advising a retail company on how to increase sales. The researchers recruited Americans online who said they had full-time jobs.

In both studies, the researchers had participants first read about COVID-19. Half read information that was designed to make them think about how dangerous and deadly the disease is. The other half read less stressful information about COVID-19, such as how to prevent transmission.

Half of the participants read a scenario in which their boss exhibited servant leadership and half read a scenario in which their boss was less supportive.

In one of the two studies, the researchers asked specifically about how much participants were worried about their own deaths.

Results were similar to the study in the Chinese company.

Those who read the more alarming news about COVID-19 reported more anxiety - general anxiety in study two and anxiety related to their own death in study three - than those who read the neutral news.

But once again, in both American studies, those who had servant leaders in their scenarios showed less anxiety, even after reading about how deadly the disease was.

And just like in the Chinese employees, the type of leadership had an impact on pro-social behavior.

Participants were paid a small amount to take part in the studies. At the end, they were given the opportunity to donate some or all of their payment to a charity fighting hunger.

Participants who had servant leaders in their scenarios were more generous to the charity than those whose bosses in the scenarios were less supportive, the study showed.

Overall, the three studies showed that companies play an important role in helping their employees cope with the stress of the COVID-19 pandemic, Hu said, which benefits both the firms and their communities.

"We found that servant leaders who keep their employees' well-being as a top concern can help their anxious workers stay engaged at work and encourage them to contribute to the broader community," she said.
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More Companies Are Using Technology To Monitor For Coronavirus In The Workplace

10/13/20




In March, Dr. Achintya Moulick found himself at the epicenter of the U.S. coronavirus pandemic.

He oversees three CarePoint Health hospitals in northern New Jersey and in the early days of the pandemic, they were swamped. "We had no idea what this infection was all about," he says.

One of the first challenges was screening patients for COVID-19 even before they entered the hospital.

"One day I saw a big line outside the entrance of the hospital," he says. "And they were manually checking everybody's temperature."

Moulick thought this was illogical. "The lines were all the way out to the garage," he says.

The process was diverting his front-line staff, burning through precious personal protective equipment and creating a bottleneck of potentially infectious patients outside his door.

So he hired a company that uses thermal scanners to take the temperature of up to 20 people at a time as they approach the front entrance.

The scanners allowed patients to flow more smoothly into the building, but the system also could alert nursing staff automatically if a patient needed immediate attention.

The thermal scanners are made by a company called Zyter. The readings can be used simply to let people in the door or for the company to keep a continuous record of employees' temperatures.

Zyter is just one of dozens of companies offering systems to help employers confront the new challenges of COVID-19.

As more and more businesses look to reopen, technology firms have an array of monitoring systems to try to keep the coronavirus out of office buildings, medical facilities and industrial plants.

This sector could be a multibillion-dollar business in the coming year, analysts say.

Some of the system are as simple as an app for employees to report any COVID-19 symptoms. Others use Bluetooth devices connected to company ID badges to make sure workers are staying at least 6 feet apart.

If someone comes down with COVID-19, the company has a record of exactly who that person had contact with, for how long, and even when exactly their temperature started to rise.

"All of that data can be tracked through a cloud-based portal on an ongoing basis," says Harish Pai, the chief technology officer at Zyter.

"So you have a complete snapshot of your organization across facilities, across locations, and what is your risk of exposure," he says.

Zyter has even more sophisticated monitoring systems that don't require any tracking devices on workers. One such system uses facial recognition linked to a network of digital cameras.

"It can track a person all through the facility and be able to identify that person," Pai says. So any potential coronavirus exposure can be identified. Rather than shutting down an entire unit of a factory if one worker gets sick, the system can identify who actually was close to the person who tested positive. Those employees can be quarantined and tested. The rest of the unit can keep working.

These COVID-19 monitoring systems raise obvious privacy concerns. Some employees will find it creepy if their every movement and even their body temperature is being tracked by their boss. Should human resources know exactly how long you spent in the bathroom?

But in the midst of the pandemic, a company may want to know if too many people are congregating in a break room or if certain units are regularly violating social distancing rules.

Employees give up many rights to privacy when they arrive at work, and courts have ruled that private companies have broad rights to monitor what happens on their premises.

Amazon is using a camera-based AI system it calls "distance assistant" to keep people spaced out in its warehouses.

Pai from Zyter says industrial plants where work from home isn't possible are some of his company's biggest customers.

"For example, we are deploying the entire contact tracing, the service and the cameras-based solution for a large manufacturing customer out of Malaysia as we speak," he says.

Some companies are adopting the bare minimum, doing just enough so the health department allows them to operate. Others like the manufacturing plant in Malaysia are monitoring every interaction at their workplace.

Kristin Baker Spohn, a partner with the tech venture capital firm CRV, says employers need to be very clear about the purpose of the new technologies they're using.

"If that purpose is the collective health of your company population, I think that's something that we'll see a lot of people be excited and eager to adapt to," she says. "But how you frame and how you protect that information is paramount to making sure that there is adoption and success."

And until there's a vaccine, the successful monitoring and suppression of the virus will be key to whether businesses can stay open.
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New study details how Michigan nursing homes limited the spread of coronavirus

10/13/20


https://www.news-medical.net/news/20201 ... virus.aspx


Seven months ago, the nation first heard of a surge of COVID-19 deaths in a Washington nursing home – an early warning sign of how the coronavirus could rip through such facilities. Since that time, more than 40% of the Americans killed by the pandemic have lived in nursing homes.

Now, a new study details how three Michigan nursing homes limited the spread of the coronavirus within their walls after the first cases were diagnosed in that early peak state.

The findings, published in the Journal of the American Geriatrics Society, could inform the ongoing effort to protect nursing home residents regionally and nationwide.

All three nursing homes in the study went into the pandemic with a proactive, partnership-based approach to general infection prevention, and response plans already in place that paved the way for effective COVID-19 containment.

This was made possible in part by their formal connections pre-COVID with Michigan Medicine, the academic medical center of the University of Michigan.

This includes embedded U-M geriatric physicians and nurse practitioners, regular meetings among clinical and administrative team members from the institutions, and a long history of involvement in U-M research. The nursing homes also connected proactively with the county health department.

Rapid action and testing

Having these plans and connections in place meant that when coronavirus cases started popping up in Michigan in mid-March, the three facilities could immediately spring into action.

One of the linchpins in their response: COVID-19 viral DNA testing offered through Michigan Medicine's in-house diagnostic laboratory, with results available within 24 hours, or at the most two days.

Proactive testing of symptomatic and asymptomatic residents, and timely test results, played a crucial role in containing the outbreak of COVID-19 in these facilities, the authors say. The in-house laboratory prioritized samples from the nursing homes, so the results came much faster than they had with the commercial laboratories that had been used at first.

" As soon as we heard of cases in the Washington nursing homes, we teamed up to devise a point-prevalence testing effort that would test asymptomatic residents, in addition to testing those with symptoms, in an effort to mitigate transmission. The results drove a tremendous effort by nursing home staff to prevent further spread to uninfected residents."

-Ana Montoya, MD, MPH, Study First Author, Medical Director for Sub-Acute Care, Michigan Medicine - University of Michigan

Montoya's co-authors include Lona Mody, M.D., M.Sc., who has studied infection transmission and prevention in nursing homes for more than a decade and was senior author of a paper published in April about pandemic preparedness among Michigan nursing homes at the start of COVID-19. She also served as a consultant to the Center for Health and Research Transformation on its independent report about Michigan nursing homes and COVID-19.

"We were particularly happy to see various teams come together in a moment of crisis with a shared purpose," says Mody. "We knew that even a little delay would have enormous consequences. Our experience shows the incredible value of research, collaboration and connections. We hope that our work informs state-level and national actions to limit devastating consequences from COVID-19."

Proactive testing recently became a federal requirement, with the frequency depending on the level of COVID-19 activity in the surrounding community. Nursing homes are also subject to reporting requirements and potential fines if they don't report testing results.

But in recent weeks, the government has sent nursing homes rapid-testing machines that are less sensitive than the "gold standard" viral DNA tests used in the study. Further research will be needed on the impact of this approach, the researchers say.

"While rapid-testing machines allow facilities to do their own testing, most facilities are still struggling with how to best utilize the machines," says Grace Jenq, M.D., the study's corresponding author, a geriatrics specialist and associate chief clinical officer for post-acute care at Michigan Medicine.

"These rapid-testing machines most likely will be used for testing symptomatic residents and staff. Test results are available within minutes, so then they can be rapidly isolated and PPE can be deployed to staff caring for the individual. Negative tests will still need to be repeated using the more sensitive PCR tests."

Testing to stop spread


In all, 29 of the 215 residents in the three Michigan nursing homes in the study were diagnosed with COVID-19 between mid-March and late April. About half required hospitalization, and six died within 14 days of diagnosis.

Sixteen of the cases were caught by testing residents who showed symptoms between March 23 and early April.

But after a proactive testing blitz of asymptomatic residents in early April, only one case of symptomatic COVID-19 was identified through April 23 in each of the nursing homes in the study.

That blitz was important because it detected 10 residents who were infected but didn't have symptoms – which could mean they were asymptomatic or pre-symptomatic. This represents a full 4.7% of all residents.

Six of the 10 residents went on to develop symptoms within a few days of their test, which means they were likely to have spread the virus to other residents and staff if their infection hadn't been detected. None of them needed hospital care.

The "blitz" of testing was carried out in a single day at each facility in early April – a time when testing people without symptoms was very unusual. It allowed the nursing homes to move infected but asymptomatic residents away from others in designated COVID-19 sections of the facility.

More than 600 staff were also tested; 3.8% tested positive and were told to stay home until their risk of transmitting the virus had gone down.

While the new study does not include longer-term patterns of infection, the authors note that infection numbers in the three nursing homes have continued to be low. A fourth nursing home also affiliated with Michigan Medicine reported no COVID-19 cases in the peak months of March and April.

Implementing existing plans

As soon as symptoms were diagnosed or a COVID test came back positive, the nursing homes followed their plan to move COVID-19 positive residents into a dedicated wing staffed by teams that only cared for COVID-positive residents.

The creation of the COVID-19 wings took a collective effort among all nursing home staff, even those not usually involved in direct resident care and cleaning. Administrative staff helped move furniture, and more.

Montoya notes that clinical teams worked together creatively to reduce unneeded interaction between staff and patients infected with the virus.

This included changing the frequency of medication dosing, procedures that could aerosolize the virus, and temporary reduction in routine blood draws and other testing. The nursing homes implemented alternative bathing options if the resident's temporary room had no shower, and arranged to bring services to them instead of having them leave their room for therapy or meals.

Staff who worked at more than one nursing home, including those not in the Michigan Medicine-linked facilities, were asked to pick one and work there exclusively, to avoid carrying the virus between facilities.

Importantly, staff received hazard pay, meals and in one nursing home, even a dedicated space to stay overnight to avoid taking the virus home to their families. Special break areas were created in areas formerly used for communal resident activities, to allow staff a space to decompress and eat during a stressful time.

The facility's leadership communicated about testing and results with residents, healthcare professionals, and families; and embarked on intensive cleaning as well as re-education efforts for staff about personal protective equipment use. The companies that own the nursing homes also made special efforts to obtain enough PPE for staff when it was in shortage.

Source:


Michigan Medicine - University of Michigan
Journal reference:

Montoya, A., et al. (2020) Partnering with Local Hospitals and Public Health to Manage COVID‐19 Outbreaks in Nursing Homes. Journal of the American Geriatrics Society. doi.org/10.1111/jgs.16869.
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Empathy can be used actively to combat the COVID-19 pandemic

10/13/20

https://www.news-medical.net/news/20201 ... demic.aspx

Empathy for vulnerable people in risk groups motivates us to use face masks and keep our distance, so that we help to prevent the spread of COVID-19, according to the study, which has just been published in the journal Psychological Science.

" We show that empathy for the most vulnerable is an important factor, and that it can be used actively to combat the pandemic. I believe that policy makers can use our new knowledge in their efforts to get more people to follow the guidelines - and ultimately save lives."

- Stefan Pfattheicher, Associate Professor, Department of Psychology and Behavioral Sciences at Aarhus BSS, Aarhus University

He is heading the study in which researchers have initially tested the relationship between participants' empathy and their attitude to social distancing. They tested this in two questionnaire-based studies in the United States, the United Kingdom, and Germany. For example, on a scale from 1 to 5, participants were asked how concerned they are about those who are most vulnerable to the coronavirus. Subsequently, they were asked about the extent to which they themselves avoid social contact due to the coronavirus. The relationship is clear. The higher the degree of empathy, the greater the focus on reducing social contact.

Equally importantly, the study shows that it is possible to induce empathy among people, and thereby also make more people willing to keep social distance and wear face masks.

Real people induce empathy


In two experiments, the researchers tested the differences in participants' willingness to follow the two recommendations, depending on whether they are just informed about the effect of the two initiatives, or whether they are also presented with a vulnerable person. In the two experiments, the participants were presented with people who, each in their own way, have been affected by and suffer from the coronavirus. There were also control groups who only received information about the effect of keeping social distance and wearing face masks. And the conclusion is clear: The participants who received the story about people suffering from the coronavirus reported a higher degree of empathy. And also a greater willingness to physically distance and use face masks.

"Our results suggest that we need stories of real people suffering. It's not enough just to tell us that we must keep a distance and wear a face mask for the sake of vulnerable citizens in general. If we're confronted with a specific person who is vulnerable to COVID-19, it is clear that empathy is strengthened, and that we are more likely to follow the guidelines," says Stefan Pfattheicher.

"Our clear recommendation is that policy makers incorporate this knowledge using empathy in their communication initiatives," says Michael Bang Petersen, a professor at the Department of Political Science, and co-author of the scientific article.

Source:

Aarhus University
Journal reference:

Pfattheicher, S., et al. (2020) The Emotional Path to Action: Empathy Promotes Physical Distancing and Wearing of Face Masks During the COVID-19 Pandemic. Psychological Science. doi.org/10.1177/0956797620964422.
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Are antibiotics being over prescribed in COVID-19?

10/13/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


A new study published on the preprint server medRxiv* in October 2020 shows that the baseline levels of inflammatory markers and C-reactive protein (CRP) in relation to antibiotic administration can rule out bacterial co-infections and help reduce the unnecessary use of antibiotics.

As the COVID-19 pandemic continues to challenge public health worldwide, it has become clear that a dysregulated and hyperactive inflammatory response is linked to severe and critical disease and a higher mortality rate. Earlier research has shown that flu and other respiratory viral illnesses can be complicated by bacterial co-infections, which can worsen inflammation and result in a higher mortality rate.

At present, few researchers think this to be the case with COVID-19 since most patients have failed to show evidence of bacteria in respiratory samples. The most commonly used tool is a microbiological culture, but this takes several days to produce a result. It is not sensitive enough and may produce confusing results by not distinguishing bacterial colonization from true infection. It is not carried out on respiratory tract samples on a routine basis in COVID-19 patients.

This has led to a high incidence of unwarranted antibiotic use in these patients, which could result in antibiotic-resistant strains of bacteria posing an increasing threat in the days ahead.

Using Novel Markers to Differentiate Bacterial vs. Viral Infection


A lot of research has gone into attempts to identify clinical and laboratory features that can classify patients with COVID-19 on the basis of the predicted outcomes. However, it is hard to differentiate between subjects with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection alone and those with a superimposed bacterial infection.

In influenza, earlier studies have explored the use of the inflammatory markers C-reactive protein (CRP), white cell count (WCC), and procalcitonin (PCT) to pick up bacterial co-infections. Measurements of these markers at specified intervals may also help in this task. While some success has been shown using neutrophil counts at admission, along with D-dimer and CRP levels, a clear definition of the changes that are predictive of bacterial pneumonia is lacking.

The current study explores this area to find clear discriminants for viral COVID-19 infections vs. those with bacterial co-infection. The parameters for bacterial pneumonia were defined using the results obtained in laboratory tests in patients with community-acquired pneumonia (CAP). These were then compared with the baseline inflammatory markers and their response to antibiotics to determine if this could provide a specific differentiation between the two.

The data came from a retrospective cohort study in a large UK teaching hospital that is located on two different campuses. The researchers found that of the patients with COVID-19, 62% were male but only about half in the cohorts with influenza or CAP. Again, Black, Asian, Mixed, and Other (non-white) ethnicity patients were disproportionately affected by COVID-19. The median age of CAP and COVID-19 patients was higher compared to those with influenza. Comorbidities were higher in CAP patients, who also were more likely to have positive cultures for bacteria.

Distinguishing Pneumonia from COVID-19

The researchers found that on comparison of inflammatory markers, the total white cell count, differential count, and CRP levels were highest in CAP vs. COVID-19 and influenza. The white cell counts were at a median of ~12.5, 6.8, and 7.2 x106/mL, respectively. Neutrophils counts showed the same association, but not lymphocyte counts.

The CRP level was higher in CAP, compared to COVID-19, at median levels of 133.5 and 86 mg/L, respectively. It was lowest in influenza, at 31 mg/L.

Antibiotics were used for the treatment of all patients with a diagnosis of CAP, as expected. However, 95% and 88% of COVID-19 patients were also treated with antibiotics, as found in two separate surveys of patients on these campuses, citing the presumed presence of bacterial co-infection.

Using this data, the researchers looked at the changes in inflammatory markers following the initiation of antibiotic therapy in these cohorts. They found that about half of patients with either CAP or COVID-19 stayed in hospital for more than 48 hours and had at least one blood draw between 48-72 hours later.

At this point, the inflammatory marker levels showed significant associations. Patients with CAP had high median white cell counts, but there was a significant fall from baseline. There was also no longer a significant difference between the CRP in CAP and COVID-19 patients. These changes were due chiefly to a pronounced reduction in white cell counts and CRP levels in CAP patients compared to COVID-19 patients.

While the white cell count dropped by a median of -2.3 x106/ml in CAP patients, the decline in COVID-19 patients was only 0.17 x106/ml, after starting antibiotics. The median CRP levels in CAP and COVID-19 were 107.5 vs. 127.0mg/L, and no longer statistically significant.

Using Multiple Discriminant Variables

These findings suggest that the use of baseline white cell counts and CRP, and a follow-up test at 48-72 hours, could discriminate between COVID-19 and CAP. The researchers then tried to discover if they could answer “Yes” or “No” to the question of whether a given patient had CAP or not. They found that the use of either white cell count or CRP by itself yielded the most accurate answer.

After adjusting for ICU admission and for the presence of proven bacterial co-infection in COVID-19 patients, they found no significant differences in the observed associations of white cell counts or CRP with CAP and COVID-19.

Discriminant Criteria: Bacterial Pneumonia vs COVID-19

The researchers then identified the cut-offs for the values of white cell counts and CRP levels that could best distinguish CAP from COVID-19. They found that using a combination of criteria, namely, both a WCC>8.2x106/ml and ΔCRP<0, could pick up 90% of cases of bacterial infection, but with a low specificity of only 43%.

Yet, they comment, “The absence of both admission WCC>8.2x106/ml and ΔCRP<0 could still exclude CAP, and by extension bacterial co-infection alongside COVID-19, promoting antibiotic cessation in 43% COVID-19 patients from this cohort.”

These findings were validated in three cohorts of patients with CAP, COVID-19, and influenza at another hospital. This showed that CAP was correctly excluded in ~46% of COVID-19 patients without positive bacterial cultures or radiological evidence of pneumonia, who were hospitalized for more than 48 hours.

Notably, almost all these patients received a full 5-day course of antibiotics. If these criteria had been applied, the antibiotics could have been stopped at 48-72 hours, preventing 51 days of antibiotics, and reducing the overall antibiotic prescriptions by a quarter.

Implications and Future Directions


The ability to discriminate these two conditions using large groups, based on readily available investigations, in a validated cohort, and the production of easily interpretable criteria, makes this study a valuable one for routine clinical purposes. At the same time, individual hospitals can modify the criteria to create cut-offs that better fit their own laboratory value distributions for CAP. Moreover, these criteria do not negate the role of clinical judgment in decision making, such as considering the patient’s need for oxygen and negative radiological signs in deciding whether antibiotics are necessary in any given case.

Further research will be necessary to compare the use of these criteria with the eventual outcome of these patients. Also, the underlying assumption of this study is that bacterial pneumonia in COVID-19 patients will have the same disease processes and inflammatory profile as in CAP without COVID-19. This requires empirical verification, though the findings of this study do not suggest its incorrectness.

The researchers suggest that the predictive power of PCT (which was not measured routinely in these cohorts and was therefore not part of the current study) should also be explored, along with D-dimer levels and perhaps even transcriptional markers indicating inflammatory cytokines.

The authors conclude: “Routine clinical parameters, admission WCC and changes in CRP following antibiotic administration, can be translated into a set of diagnostic criteria that can exclude bacterial co-infection in up to half of COVID-19 patients.” This could pave the way for rational antibiotic prescription protocols to assist antibiotic stewardship.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Journal reference:

Mason, C. Y. et al. (2020). Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics. medRxiv preprint. doi: https://doi.org/10.1101/2020.10.09.20199778. https://www.medrxiv.org/content/10.1101 ... 20199778v1
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Using pooled wastewater testing to detect COVID-19 cases

10/13/20


https://www.news-medical.net/news/20201 ... cases.aspx


A pilot study testing wastewater from buildings as a surveillance method for COVID-19 found it to be a feasible method for detecting positive cases in highly occupied settings like dormitories.

As the COVID-19 pandemic sweeps across the globe, several strategies have been put into place to prevent the spread, such as social distancing and wearing a mask.

However, maintaining a distance and always wearing a mask is difficult, especially in places like college dormitories, nursing homes, and prisons, where many people are gathered, mainly indoors. Entry screening and temperature checks have not contained infection spread effectively as people may be contagious even when they have no symptoms. This has led to a spike in cases in such settings.

Cases may be reduced in close-living settings by frequent testing and quickly isolating people who have tested positive and quarantining their contacts. However, regular testing is expensive, requires testing personnel, and may lead to anxiety among occupants.

Stool has large amounts of mainly non-viable SARS-CoV-2 virus, and the virus is shed for many weeks after the infection. This observation has led to a great interest in testing wastewater for monitoring the infection at a community level.

This could be very useful for monitoring infection in buildings and potentially serve as early surveillance of occupants. Wastewater testing could also help determine when and where interventions are required, without the need for large-scale and frequent individual testing.

Wastewater testing protocols


In a new study published on the preprint server medRxiv*, researchers investigated if testing pooled wastewater samples frequently could be an efficient method of monitoring COVID-19 infections in a building.

The researchers collected wastewater samples from a hospital building and dormitories at the University of Virginia, and wastewater from a water treatment plant in Charlottesville, Virginia, and from a private residence.

The team had to ensure that the samples collected were connected to the waste coming COVID-19 unit in the hospital. For this, they used a dye to trace the flow of wastewater and, after a couple of tries, decided on a location that was connected to patient rooms in the hospital building.

From the collected samples, the authors used four different methods to concentrate the virus particles and recover viral RNA. They extracted RNA using commercial RNA extraction kits and tested for SARS-CoV-2 using RT-PCR.

They found that SARS-CoV-2 was detectable in wastewater from the buildings and the water treatment plant. The ultracentrifugation concentration protocol showed the least inhibition and more positive results. Water from the water treatment plant did not need any concentration protocol as the solids settled down by gravity.

Wastewater testing is feasible for detecting SARS-CoV-2


To validate the results of the wastewater analysis, the team compared the cycle threshold, Ct, values to the known case counts in the buildings. They found a sensitivity of about 95% and a specificity of about 100%, except when there was a recovered patient, which they missed, and the specificity dropped to about 50%. Thus, the method cannot differentiate between the presence of a new contagious patient and a recovered patient with continued viral shedding.

After analyzing the results, the team found that the number of occupants in a building plays a role in the ability to detect the virus in wastewater. There was one instance when a positive case was not detected in a building with 15 people. This may be because low water use meant less sample collection.

Thus, the authors write this method may be more suitable for larger buildings with more than 20 people.

Another important factor in detecting SARS-CoV-2 in wastewater is when, after collection, sample processing, and testing was done. They found that detection of SARS-CoV-2 decreased slightly the longer it took for the samples to be processed and tested.

So, it is critical to prevent RNA degradation after sample collection, for example, by refrigerating or storing the samples in ice until processing. Long travel times of the samples to testing facilities may reduce viral RNA detectability and could decrease the usefulness of wastewater testing as a surveillance method.

For sample concentration, the authors found ultracentrifugation to be the best. However, it requires costly ultracentrifuges, and it is a batch process, which may not be very convenient when testing a large number of samples.

Another key aspect of wastewater samples is effective RNA extraction. Both the two commercial kits the team tested showed inhibition. Hence, RNA extraction protocols need to be carefully tested and optimized to ensure good detection sensitivity.

With the specificity and sensitivity detected, the authors believe the method can be used to detect cases in buildings even when the number of cases is small or in asymptomatic cases. Once there is a positive result using this method, individual testing of all building residents can be performed for detecting individual cases.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Colosi, L. M. et al. (2020) Development of wastewater pooled surveillance of SARS-CoV-2 from congregate living settings. medRxiv. https://www.medrxiv.org/content/10.1101 ... 20210484v1
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Blood profile could help identify COVID-19 patients at greatest risk of deterioration

10/14/20


https://www.news-medical.net/news/20201 ... ation.aspx

Southampton researchers have identified a blood profile that could help identify COVID-19 patients at greatest risk of deterioration and direct them towards trials of specific treatments that could modify their immune systems' responses.

A new study jointly led by Professor Tom Wilkinson and Dr Tristan Clark of the University of Southampton, has shown a blood test for five cytokines could help predict those at risk of life-threating overstimulation of immune defences by COVID-19, and potentially tailor their treatment to tackle this.
Preventing a cytokine storm

Cytokines are cell signalling molecules with many associated with inflammation released into the bloodstream after an infection, helping to drive protective immune responses.

In patients with severe COVID-19, the immune system can overreact leading to massively increased cytokine levels in the blood - a 'cytokine storm'. Instead of helping the body fight the virus, this overreaction is extremely damaging to the cells and tissues of the body itself and can be fatal.

Identifying those more prone to this response, and tackling the hyperinflammation could be a key route to reducing the severity of COVID-19 and deaths.

Identifying patients most at risk


The study, published in Respiratory Research, analyzed blood samples from 100 COVID-19 positive patients between 20 March and 29 April 2020, during the first phase of the pandemic.

They found that high levels of cytokines IL-6, IL-8, TNF, IL-1β and IL-33 in the patients' blood on admission were associated with greater chance of needing intensive care, artificial ventilation and of dying. IL-1β and IL-33 showed the biggest effect.

Combining this cytokine test with a clinical assessment of the patients' condition could help doctors identify and treat those most at risk of deteriorating.

Dr Anna Freeman and Dr Hannah Burke, Respiratory Clinical Research Fellows and joint first authors commented: "This project was a great opportunity for collaboration within the Faculty of Medicine, using resource from both the respiratory and infectious diseases teams.

"As early career researchers this study provided us with a valuable learning opportunity about how to deliver academic impact within the evolving COVID-19 pandemic."

Investigating new treatments


Two treatments for those hospitalized with COVID-19 have been found so far, with the steroid dexamethasone shown to reduce deaths by up to a third, in patients needing oxygen. The mechanism for Dexamethasone's protective effects isn't known, but as a non-specific anti-inflammatory it points to the potential benefit of controlling the inflammatory immune response.

The Southampton team hope that by accurately identifying which cytokines are driving hyperinflammation in each COVID-19 patient, doctors could target them (such as with an IL-33 blocker current in UK trials), yielding the biggest benefits for individual patients- an approach known as 'precision medicine'.

" These findings, from the ongoing COVID research programme in Southampton, have identified important inflammatory signals which will help steer the development of treatment strategies for this new disease. It is increasingly apparent that COVID is highly heterogeneous. Only by applying these techniques to stratify the condition will we be able to target the key mechanisms of disease with the best treatment for that individual."

- Tom Wilkinson, Professor

Dr Tristan Clark said: "Our findings suggest that testing for both COVID-19 and cytokines at the point-of-care is feasible and in the future may identify infected patients and the most appropriate treatment for them, in near real-time."
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Exploring the effects of smoking tobacco on COVID-19 risk

10/14/20


https://www.news-medical.net/news/20201 ... -risk.aspx


A study conducted by researchers in China has shed light on how certain tobacco compounds might prevent cells from becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent that causes coronavirus disease 2019 (COVID-19).

However, given that tobacco smoking is associated with more severe COVID-19 among those who become infected and that the compounds identified were carcinogens, the generalized advice to quit smoking remains valid, say the study authors.

“Tobacco use should not be recommended, and a cessation plan should be prepared for smokers in COVID-19 pandemic,” write Guang-Biao Zhou (Chinese Academy of Medical Sciences, Beijing) and colleagues.

A pre-print version of the paper is available in the server medRxiv* while the article undergoes peer review.

The controversy surrounding smoking and COVID-19

“The association between tobacco smoking and COVID-19 incidence and severity remains controversial,” said the researchers.

Since the COVID-19 pandemic began in Wuhan, China, late last year, one unexpected finding has been that smokers only make up around 1.4 to 18.5% of hospitalizations.

However, according to the World Health Organization, smoking is associated with increased rates of severe COVID-19 and death.

Tobacco smoke also accounts for more than 8 million deaths per year globally, with 7 million dying from smoking and 1.2 million dying due to exposure to second-hand smoke.

“Great efforts should be made to reduce tobacco use and help smokers to quit,” say Zhou and team.

What have studies found so far?

Since researchers noticed associations between tobacco smoking and COVID-19 incidence, significant efforts have been made to determine the role tobacco smoking might play in SARS-CoV-2 infection.

So far, studies have shown that levels of angiotensin-converting enzyme 2 (ACE2) - the host cell receptor for SARS-CoV-2 – are higher in the lung tissue of non-smokers than in that of smokers. Studies have also shown that tobacco carcinogens downregulate ACE2 in mice.

Furthermore, Zhou and colleagues say one study showed that cigarette smoke extract (CSE) inhibits SARS-CoV-2 spike protein pseudovirus infection, thereby supporting findings that smokers may be at a lower risk of SARS-CoV-2 infection, as compared with the general population.

The spike protein is the main surface structure the virus uses to bind to ACE2 and gain access to host cells. Pseudoviruses are virus-like particles that lack the ability to replicate and are, therefore, useful tools in virology research, owing to their safety and versatility.

Among the tobacco compounds tested, it was benzo(a)pyrene BaP and nicotine-derived nitrosamine ketone (NNK) that stopped the SARS-CoV-2 spike protein pseudovirion from infecting cells. Both of these substances are notorious carcinogens that have various adverse health effects, says the team.

Another study has also shown that BaP triggers upregulation of the oncoprotein Skp2, which plays an essential role in cell cycle progression and proliferation.

What did the current study find?

The researchers showed that in specimens harvested from normal lung tissues, CSE and BaP exert a dual effect on ACE2, upregulating ACE2 mRNA on the one hand and triggering catabolism of the ACE2 protein on the other.

BaP induced significant upregulation of Skp2, which interacts with ACE2 and induces ubiquitination and subsequent degradation of the substrate.

“Proteasome and lysosome are two critical sites for degradation of ubiquitinated substrate proteins,” writes Zhou and colleagues.

The team found that the lysosome was partially responsible for the BaP-induced degradation of ACE2. When human bronchial epithelial (16HBE) cells were co-incubated with 40 µM of the lysosome inhibitor chloroquine for 36 hours, ACE2 was partially rescued from BAP-triggered catabolism.

Proteasome also played a role in the catabolism of ACE2; when the cells were co-incubated with 10 µM of the proteasome inhibitor MG132 for 12 hours, the degradation of ACE2 was again partially suppressed.


“The fact that inhibition of either proteasome or lysosome can partially but not completely block the degradation of ACE2 suggests that both organelles are critical to ACE2 catabolism, and the role of other forms of post-translational modification in ACE2 catabolism warrants further investigation,” writes the team.

“Tobacco use should not be recommended”


The researchers say their results partially unveil the mechanisms underlying the action of tobacco carcinogens on ACE2. Whether ACE2 proteolysis can account for disease severity among COVID-19 patients needs to be determined in future studies, they add.

In the meantime, the team points out that ACE2 is required to maintain lung and cardiovascular functions.

Furthermore, “given that tobacco smoke accounts for 8 million deaths including 2.1 million cancer deaths annually and Skp2 is an oncoprotein, tobacco use should not be recommended and cessation plan should be prepared for smokers in COVID-19 pandemic,” conclude Zhou and colleagues.

*Important Notice

bioRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Zhou GB, et al. Degradation of SARS-CoV-2 receptor ACE2 by tobacco carcinogen-induced Skp2 in lung epithelial cells. bioRxiv, 2020. doi: https://doi.org/10.1101/2020.10.13.337774, https://www.biorxiv.org/content/10.1101 ... 3.337774v1
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Lockdowns improved air quality, averted tens of thousands of deaths in severely polluted regions

10/14/20

https://www.news-medical.net/news/20201 ... gions.aspx


Lockdowns initiated to curb the spread of the coronavirus in China and Europe at the beginning of the pandemic improved air quality, averting tens of thousands of deaths in regions where air pollution has a significant impact on mortality, a new study shows.

According to research published in The Lancet Planetary Health, scientists at the University of Notre Dame found that particulate matter concentrations in China dropped by an unprecedented 29.7 percent, and by 17.1 percent in parts of Europe, during lockdowns that took place between Feb. 1 and March 31 in China and Feb. 21 to May 17 in Europe. Particulate matter (PM2.5) -; tiny airborne particles smaller than 1/10,000 of an inch in diameter -; comes from various combustion-related sources including industrial emissions, transportation, wildfires and chemical reactions of pollutants in the atmosphere.

" We look on these lockdowns as the first global experiment of forced low-emission scenarios. This unique, real-world experiment shows us that strong improvements in severely polluted areas are achievable even in the short term, if strong measures are implemented."

- Paola Crippa, Study Corresponding Author and Assistant Professor, Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame

Air pollution is considered the leading environmental cause of death. In 2016, the World Health Organization attributed air pollution to 4.2 million premature deaths worldwide, with Western Pacific and Southeast Asian regions being the most affected. Long-term exposure can be hazardous to human health, with premature death associated to lung cancer, ischemic heart disease, stroke and chronic obstructive pulmonary diseases.

Crippa and her team integrated advanced computer simulations with measured particulate matter concentrations from more than 2,500 sites in Europe and China in total between Jan. 1, 2016, and June 30, 2020 -; during which both regions initiated lockdowns as COVID-19 began spreading rapidly.

The team estimated rates of premature death against four different economic recovery scenarios: an immediate resumption to normal activity and subsequent emissions, a gradual resumption with a three-month proportional increase of emissions, the potential of a second outbreak of COVID-19 between October and December in each region, and a permanent lockdown for the remainder of 2020 in the case of ineffective control strategies.

"The most surprising part of this work is related to the impact on human health of the air quality improvements," Crippa said.

"It was somewhat unexpected to see that the number of averted fatalities in the long term due to air quality improvements is similar to the COVID-19 related fatalities, at least in China where a small number of COVID-19 casualties were reported. These results underline the severity of air quality issues in some areas of the world and the need for immediate action."

From February to March, the study found an estimated 24,200 premature deaths associated with particulate matter were averted throughout China compared to 3,309 reported COVID-19 fatalities, and "improvements in air quality were widespread across China because of extended lockdown measures." The study found the situation in Europe to be quite different.

While COVID-19 related deaths were far higher in Europe compared to what was reported in China, an estimated 2,190 deaths were still avoided during the lockdown period when compared to averages between 2016 and 2019.

The averted fatalities figures become much larger (up to 287,000 in China and 29,500 in Europe) when considering long-term effects, which will depend on the future pathway of economic recovery.

The study serves as an example of the need for ad hoc control policies to be developed to achieve effective air quality improvements, said Crippa, and highlights the issue of risk perception between the current immediate crisis of the coronavirus pandemic versus the ongoing crisis of hazardous pollutants in the atmosphere.

"In China, we saw that lockdowns implied very significant reductions in PM2.5 concentrations, which means that policies targeting industrial and traffic emissions might be very effective in the future," Crippa said. "In Europe those reductions were somewhat smaller but there was still a significant effect, suggesting that other factors might be considered to shape an effective mitigation strategy."

Those strategies could include subsidies to electric vehicles, prioritizing public transport in heavily trafficked cities and adoption of more stringent emission limitations for industries. Heating emissions and agriculture are also contributors to total particulate matter concentrations.

In the study, researchers stressed that aggressive mitigation strategies to reduce air pollution could achieve significant improvements to health, stating, "If interventions of a similar scale to those adopted to address the COVID-19 pandemic were widely and systematically adopted, substantial progress towards solving the most pressing environmental and health crisis of our time could be achieved."

Source:

University of Notre Dame

Journal reference:


Giani, P., et al. (2020) Short-term and long-term health impacts of air pollution reductions from COVID-19 lockdowns in China and Europe: a modelling study. Lancet Planetary Health. doi.org/10.1016/S2542-5196(20)30224-2.
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