Moldable Mask: A Reusable,Hot Water Moldable,Additively Manufactured Mask to Be Used as an N95 Alternative

There has been high demand for personal protective equipment (PPE) during the COVID-19 pandemic, especially N95 respirators. Unfortunately, at the early stage of the pandemic, the supply could not meet the demand for N95 respirators, leading to a shortage and unsafe reuse of this form of PPE. We developed the Moldable Mask to ease the demand for N95 respirators by creating a 3D-printed mask that uses a piece of N95 material as a filter. A sheet of N95 material could be used or one N95 respirator to be turned into two masks. The main feature of the mask is the ability to easily mold it in hot water to create a custom fit for each user. It can also be easily assembled at home with affordable materials. The final mask design was qualitatively fit tested on 13 subjects, with all subjects showing an improvement in fit with the hot water molding technique and 10 (77%) subjects passing the fit test. This shows that the Moldable Mask is a viable option for a safe, affordable N95 alternative when N95 mask supply is strained.     

A Year of Critical Care: The Changing Face of the ICU During COVID-19

During the SARS-CoV-2 pandemic, admissions to hospital intensive care units (ICUs) surged, exerting unprecedented stress on ICU resources and operations. The novelty of the highly infectious coronavirus disease 2019 (COVID-19) required significant changes to the way critically ill patients were managed. Houston Methodist’s incident command center team navigated this health crisis by ramping up its bed capacity, streamlining treatment algorithms, and optimizing ICU staffing while ensuring adequate supplies of personal protective equipment (PPE), ventilators, and other ICU essentials. A tele–critical-care program and its infrastructure were deployed to meet the demands of the pandemic. Community hospitals played a vital role in creating a collaborative ecosystem for the treatment and referral of critically ill patients. Overall, the healthcare industry’s response to COVID-19 forced ICUs to become more efficient and dynamic, with improved patient safety and better resource utilization. This article provides an experiential account of Houston Methodist’s response to the pandemic and discusses the resulting impact on the function of ICUs.     

WinSAAM: a windows-based compartmental modeling system

Over the last 50 years, complex, dynamic, compartmental models have been used to describe and to make predictions on a host of pharmacokinetic, metabolic, and biological systems. Sophisticated modeling software is required to fit data to such models and to make predictions using these compartmental models. WinSAAM is one such modeling program. The purpose the current report is to describe the features of WinSAAM that make this program suited for modeling all manner of biological systems. We highlight new features, especially those that are unique to WinSAAM, and illustrate with examples how WinSAAM is used to construct models of metabolic systems, to simulate the effects of experiments on systems, and to fit models to data.     

Transitioning From Room to Zoom: The 2020 Cardiovascular Fellows’ Boot Camp in the COVID-19 Era

For 10 years, the annual Houston Methodist Cardiovascular Fellows’ Boot Camp hosted hundreds of cardiovascular trainees in Houston for a concise yet comprehensive 3-day training program for new fellows. The cornerstone of the program was the hands-on Skills Academy, which included a variety of timed learning stations that taught surgical techniques, dissection skills, and suturing techniques as well as echocardiography and cardiac catheterization using simulators. This was followed by 2 days of didactics covering essential topics in each specialty. However, that model was upended in 2020 by the COVID-19 pandemic. The pandemic forced the digitization of medical education and posed significant challenges as we transitioned Boot Camp to a virtual format. In this editorial, we review our experience designing and implementing a virtual cardiology track of the Houston Methodist Cardiovascular Fellows’ Boot Camp and highlight challenges and proposed solutions in the era of virtual education.     

Patient-reported outcomes measures (PROMs) and patient-reported experience measures (PREMs) of COVID-19 telerehabilitation: Prospective pilot program

Telemedicine is proving to be a useful tool in the telemonitoring of respiratory patients and telerehabilitation programs. The use of telemedicine has been proposed by the main medical societies because of the limited resources and the healthcare workers infection risk in the Coronavirus Disease 2019 (COVID-19) pandemic.The aim of this pilot program is to evaluate the feasibility of COVID-19 telerehabilitation program from the hospital to the home with clinical, functional and patient satisfaction outcomes. Rehabilitation was initiated in the hospital by a physiotherapist and complemented by “Estoi” (a mobile application), which was continued at home with telemonitoring and messaging with the medical team. Patients’ habitual use of smartphones was not queried for inclusion.Sixteen patients were consecutively enrolled, 47% women with a mean age of 63 years old. 50% of patients completed ≥15 rehabilitation sessions. In total, 88% of patients referred that the mobile application incentive them to do more physical therapy, and 63% would choose telerehabilitation instead of center-based rehabilitation for new rehabilitation programs. Patient satisfaction (0–10) for the mobile application was 8.4 and 8.9 for the telerehabilitation program.Beginning telerehabilitation in the hospital could increase the efficacy and efficiency of physical therapy, which is safe for patients and healthcare workers. Following at home, this telerehabilitation program seems to encourage and empower patients who have reported high satisfaction. Further randomized studies with larger numbers of patients and multicenter studies are required to evaluate these results.     

Frailties and critical issues in neuromuscular diseases highlighted by SARS-CoV-2 pandemic: how many patients are still “invisible”?

Almost 90% of neuromuscular diseases (NMDs) are classified as rare diseases, defined as conditions affecting less than 5 individuals in 10.000 (0.05%). Their rarity and diversity pose specific challenges for healthcare and research. Epidemiological data on NMDs are often lacking and incomplete. The COVID-19 pandemic has further highlighted the management difficulties of NMDs patients and the necessity to continue the program of implementation of standard of care. This article summarizes the Italian experience during pandemic.Key words: COVID-19 pandemic, neuromuscular diseases     

COVID-19 vaccination in India: An ethical perspective

Background and aimsCOVID-19 had put world to a standstill with enormous morbidity and mortality. Vaccines’ development against this provided a beacon of hope. India approved different vaccines under emergency use authorization but distribution of vaccines and vaccination of huge population was a challenging task. We attempted to review the vaccination program from an ethics perspective.MethodsThe core ethical principles of healthcare and other tenets put forth in discussion papers on addressing ethical issues in pandemic influenza planning, ethical considerations in developing a public health response to pandemic influenza and World Health Organization (WHO) Scientific Advisory Group for Emergencies values framework for the allocation and prioritization of COVID-19 vaccination were used to identify the ethical concerns in the vaccination program of the country. Relevant ministry guidelines, documents, websites etc., were accessed.ResultsThe program tried addressing many of the ethical principles laid out in various international documents. Approving indigenously produced vaccines upheld the principle of utility while prioritizing health care workers for vaccination was an example of reciprocity. However, vaccine approval without availability of trial results in public domain raised apprehensions and lacked transparency. Lack of well-defined mechanism to facilitate vaccination for socially disadvantaged groups compromises equity.ConclusionOverall, the program fared well on most aspects of ethical principles, but there were few gaps which still exist. These should be taken care of as the country advances further into vaccination program to garner enhanced public trust in the scientific, regulatory and administrative authorities.     

TB positive cases go up in ongoing COVID-19 pandemic despite lower testing of TB: An observational study from a hospital from Northern India

The whole world is wrestling against SARS-CoV-2 infection (COVID-19). COVID-19-TB co-infection is also reported but there are limited number of studies which analyze the impact of COVID-19 pandemic in TB diagnosis and management. In this retrospective study, we observed that the TB diagnosis was reduced in pandemic time. Before COVID-19 pandemic (March–December 2019), there were 644 TB tests out of which 127 were TB positive. In ongoing COVID-19 pandemic (January–October 2020), 484 TB tests were performed and 146 patients were TB positive. Male accounted for 64%/57% of TB cases in 2019/2020 whereas female patients were 35%/42% in 2019/2020. Increase in female TB positive cases was a noticeable feature. The newly diagnosed with TB cases in 2019/2020 were 112/130 respectively. Though, we have seen only 7 COVID-TB co-infection cases, we could not establish the causal relationship in COVID-TB co-infection. The increase in the number of TB positive cases during COVID-19 pandemic clearly showed how adversely COVID-19 has affected TB diagnosis and management. Anticipating the increase in TB cases in future, we emphasize the need to ensure continuous TB testing and treatment despite the pandemic burden. Further study on the COVID-TB co-infection in high TB-burden countries like India, is required to enable analyses of interactions, risk factors in COVID-19-TB co-infection.     

Protecting residential care facilities from pandemic influenza

It is widely believed that protecting health care facilities against outbreaks of pandemic influenza requires pharmaceutical resources such as antivirals and vaccines. However, early in a pandemic, vaccines will not likely be available and antivirals will probably be of limited supply. The containment of pandemic influenza within acute-care hospitals anywhere is problematic because of open connections with communities. However, other health care institutions, especially those providing care for the disabled, can potentially control community access. We modeled a residential care facility by using a stochastic compartmental model to address the question of whether conditions exist under which nonpharmaceutical interventions (NPIs) alone might prevent the introduction of a pandemic virus. The model projected that with currently recommended staff–visitor interactions and social distancing practices, virus introductions are inevitable in all pandemics, accompanied by rapid internal propagation. The model identified staff reentry as the critical pathway of contagion, and provided estimates of the reduction in risk required to minimize the probability of a virus introduction. By using information on latency for historical and candidate pandemic viruses, we developed NPIs that simulated notions of protective isolation for staff away from the facility that reduced the probability of bringing the pandemic infection back to the facility to levels providing protection over a large range of projected pandemic severities. The proposed form of protective isolation was evaluated for social plausibility by collaborators who operate residential facilities. It appears unavoidable that NPI combinations effective against pandemics more severe than mild imply social disruption that increases with severity.     

Fit genotypes and escape variants of subgroup III Neisseria meningitidis during three pandemics of epidemic meningitis

The genetic variability at six polymorphic loci was examined within a global collection of 502 isolates of subgroup III, serogroup A Neisseria meningitidis. Nine "genoclouds" were identified, consisting of genotypes that were isolated repeatedly plus 48 descendent genotypes that were isolated rarely. These genoclouds have caused three pandemic waves of disease since the mid-1960s, the most recent of which was imported from East Asia to Europe and Africa in the mid-1990s. Many of the genotypes are escape variants, resulting from positive selection that we attribute to herd immunity. Despite positive selection, most escape variants are less fit than their parents and are lost because of competition and bottlenecks during spread from country to country. Competition between fit genotypes results in dramatic changes in population composition over short time periods.     

Impact of COVID-19 on the surgical volume of general surgery residents as main surgeons in a National Training Program in Costa Rica: A cross-sectional study

To quantify the impact of coronavirus disease 19 (COVID-19) on the surgical volume of residents’ medical practice in Costa Rica''s General Surgery Residency Program.The COVID-19 pandemic has caused a significant disruption in people''s lives. Health systems worldwide have been forced to adapt to the new normal, which has posed a challenge for medical residency programs, especially in the surgical field.This transversal study includes the surgical records of all residents of the General Surgery program who worked as main surgeons at the Mexico Hospital of the Costa Rican Social Security between December 23, 2019, and June 25, 2020.As main surgeons, a total of 10 residents performed 291 pre-pandemic surgeries and 241 pandemic surgeries.When comparing the distribution of procedures performed by residency levels, it is observed that the postgraduate year -2 increased the number of procedures performed during the pandemic period (pre-pandemic 19% vs pandemic 27%, P = .028). There was no statistically significant difference between the pre-pandemic and pandemic periods in the remaining levels.When comparing the procedures by unit, a statistically significant decrease was observed in the Endocrine-Abdominal Wall Unit (pre-pandemic 18.3% vs pandemic 5.4%, P < .001). Conversely, a statistically significant increase was identified in Surgical Emergencies Unit procedures (40.0% vs post 51.7%, P = .007). No statistically significant differences were observed in the remaining the Units.The COVID-19 pandemic had no statistically significant effect on surgeries performed by residents of the General Surgery Residency Program as main surgeons in a national training center in Costa Rica. The Department''s timely measures and pro-resident attitude were the key reasons for the above results.     

Changes in healthcare workers’ knowledge,attitudes, practices,and stress during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) has caused an unprecedented health crisis around the world, not least because of its heterogeneous clinical presentation and course. The new information on the pandemic emerging daily has made it challenging for healthcare workers (HCWs) to stay current with the latest knowledge, which could influence their attitudes and practices during patient care.This study is a follow-up evaluation of changes in HCWs’ knowledge, attitudes, and practices as well as anxiety levels regarding COVID-19 since the beginning of the pandemic. Data were collected through an anonymous, predesigned, self-administered questionnaire that was sent online to HCWs in Saudi Arabia.The questionnaire was sent to 1500 HCWs, with a 63.8% response rate (N = 957). The majority of respondents were female (83%), and the most common age group was 31 to 40 years (52.2%). Nurses constituted 86.3% of the respondents. HCWs reported higher anxiety during the COVID-19 pandemic which increased from 4.91 ± 2.84 to 8.6 ± 2.27 on an 11-point Likert scale compared to other viral outbreaks. HCWs believed that their own preparedness as well as that of their hospital''s intensive care unit or emergency room was higher during the COVID-19 pandemic than during the Middle East respiratory syndrome coronavirus pandemic (2012–2015). About 58% of HCWs attended one or more simulations concerning the management of COVID-19 patients in their intensive care unit/emergency room, and nearly all had undergone N95 mask fit testing. The mean score of HCWs’ knowledge of COVID-19 was 9.89/12. For most respondents (94.6%), the perception of being at increased risk of infection was the main cause of anxiety related to COVID-19; the mean score of anxiety over COVID-19 increased from 4.91 ± 2.84 before to 8.6 ± 2.27 during the pandemic in Saudi Arabia.HCWs’ anxiety levels regarding COVID-19 have increased since a pandemic was declared. It is vital that healthcare facilities provide more emotional and psychological support for all HCWs.     

Original research: UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

IntroductionThe COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020.ResultsDuring the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training.ConclusionsReductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.     

Performance Characteristics of Real-Time PCRs for African Swine Fever Virus Genome Detection—Comparison of Twelve Kits to an OIE-Recommended Method

African swine fever (ASF) is a major threat to pig production, and real-time PCR (qPCR) protocols are an integral part of ASF laboratory diagnosis. With the pandemic spread of ASF, commercial kits have risen on the market. In Germany, the kits have to go through an approval process and thus, general validation can be assumed. However, they have never been compared to each other. In this study, 12 commercial PCR kits were compared to an OIE-recommended method. Samples representing different matrices, genome loads, and genotypes were included in a panel that was tested under diagnostic conditions. The comparison included user-friendliness, internal controls, and the time required. All qPCRs were able to detect ASFV genome in different matrices across all genotypes and disease courses. With one exception, there were no significant differences when comparing the overall mean. The overall specificity was 100% (95% CI 87.66–100), and the sensitivity was between 95% and 100% (95% CI 91.11–100). As can be expected, variability concerned samples with low genome load. To conclude, all tests were fit for purpose. The test system can therefore be chosen based on compatibility and prioritization of the internal control system.     

Large-scale decontamination of disposable FFP2 and FFP3 respirators by hydrogen peroxide vapour,Finland, April to June 2020

BackgroundThe shortage of FFP2 and FFP3 respirators posed a serious threat to the operation of the healthcare system at the onset of the COVID-19 pandemic.AimOur aim was to develop and validate a large-scale facility that uses hydrogen peroxide vapour for the decontamination of used respirators.MethodsA multidisciplinary and multisectoral ad hoc group of experts representing various organisations was assembled to implement the collection and transport of used FFP2 and FFP3 respirators from hospitals covering 86% of the Finnish population. A large-scale decontamination facility using hydrogen peroxide vapour was designed and constructed. Microbiological tests were used to confirm efficacy of hydrogen peroxide vapour decontamination together with a test to assess the effect of decontamination on the filtering efficacy and fit of respirators. Bacterial and fungal growth in stored respirators was determined by standard methods.ResultsLarge-scale hydrogen peroxide vapour decontamination of a range of FFP2 and FFP3 respirator models effectively reduced the recovery of biological indicators: Geobacillus stearothermophilus and Bacillus atrophaeus spores, as well as model virus bacteriophage MS2. The filtering efficacy and facial fit after hydrogen peroxide vapour decontamination were not affected by the process. Microbial growth in the hydrogen peroxide vapour-treated respirators indicated appropriate microbial cleanliness.ConclusionsLarge-scale hydrogen peroxide vapour decontamination was validated. After effective decontamination, no significant changes in the key properties of the respirators were detected. European Union regulations should incorporate a facilitated pathway to allow reuse of appropriately decontaminated respirators in a severe pandemic when unused respirators are not available.     

Logistical feasibility and potential benefits of a population-wide passive-immunotherapy program during an influenza pandemic

Treatment strategies for severe cases of pandemic influenza have focused on antiviral therapies. In contrast, passive immunotherapy with convalescent blood products has received limited attention. We consider the hypothesis that a passive-immunotherapy program that collects plasma from a small percentage of recovered adults can harvest sufficient convalescent plasma to treat a substantial percentage of severe cases during a pandemic. We use a mathematical model to estimate the demand and supply of passive immunotherapy during an influenza pandemic in Hong Kong. If >5% of 20- to 55-year-old individuals recovered from symptomatic infection donate their plasma (donor percentage > 5%), >67% of severe cases can be offered convalescent plasma transfusion (treatment coverage > 67%) in a moderately severe epidemic (R ₀ < 1.4 with 0.5% of symptomatic cases becoming severe). A donor percentage of 5% is comparable to the average blood donation rate of 38.1 donations per 1,000 people in developed countries. Increasing the donor percentage above 15% does not significantly boost the convalescent plasma supply because supply is constrained by plasmapheresis capacity during most stages of the epidemic. The demand–supply balance depends on the natural history and transmission dynamics of the disease via the epidemic growth rate only. Compared to other major cities, Hong Kong has a low plasmapheresis capacity. Therefore, the proposed passive-immunotherapy program is a logistically feasible mitigation option for many developed countries. As such, passive immunotherapy deserves more consideration by clinical researchers regarding its safety and efficacy as a treatment for severe cases of pandemic influenza.     

Changing patterns of household transmission of tuberculosis in an eastern state of India: The impact of COVID19 pandemic

BackgroundThe COVID-19 Pandemic has affected many components of the Tuberculosis (TB) control program. Due to lockdown and restrictions, people, including TB patients, might have spent more time in the household. There might be an increased TB transmission among the household contacts (HHC). The current study was conducted to measure the household transmission of TB and also find out the relationship with several clinico-social factors.MethodsContact tracing data of West Bengal, India, was extracted from Nikshay portal of Central TB Division, Government of India. The anonymized data was divided into two parts, firstly before the lockdown initiation in India and secondly during the lockdown. A modified Poisson regression model was developed to determine the statistical association between clinico-social variables and the pandemic with household-level secondary TB cases.ResultsThere was a 30% reduction in daily TB case notification, but the proportion of HHC screened was 4% higher during the pandemic than the pre-pandemic period. The secondary attack rate of household TB disease transmission was 34% lower during the pandemic period. Index TB patients aged under ten years, microbiologically positive, Drug-Resistant TB, having three or more HHCs, treatment delay more than seven days, notified from the private sector, and diagnosis during the pre-pandemic period was found to be independently associated with a higher risk of having a secondary TB case at household.ConclusionThe risk of household TB transmission was significantly lower during the pandemic period compared to the pre-pandemic period, which may be due to better infection prevention and control practices.     

Awareness,Perception, and Practices Towards Blood Donation Among Undergraduate Health Science Students of India During the COVID-19 Pandemic

To assess the awareness, perception, and practices of health science students towards blood donation during the COVID-19 pandemic. This cross-sectional study was done among the undergraduate medical, dental, physiotherapy, and audiology, speech and learning pathology students in May 2021. A self-administered questionnaire designed using Google Doc was used for data collection. Out of the 461 participants, only 171(37.1%) knew that Coronavirus was not transmitted through blood transfusion. Only 125(27.1%) participants knew that a minimum of 14 days is required before a donor who tested positive for COVID-19 can donate blood. As many as 339(73.5%) participants expressed their willingness to donate blood during the current pandemic. Having donated blood in the past (p = 0.001), having vaccinated with COVID-19 vaccines (p = 0.029), having taken both the vaccine doses (p = 0.0499), and absence of anaemia (p = 0.0159) were associated with willingness to donate blood during the pandemic. Only 83(18%) participants had donated blood after the onset of the pandemic. Out of the rest 378, 106(28%) participants did not donate blood due to the fear of getting infected with Coronavirus. Absence of chronic co-morbidities (p = 0.0288) was associated with the history of having donated blood after the onset of COVID-19 pandemic among the participants. Awareness of participants regarding certain key issues related to blood donation and COVID-19 were found lacking. Counselling services to alleviate fears associated with blood donation and awareness sessions to remove misconceptions are required among students to improve blood donation practices.     

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

IntroductionThere has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter.MethodsWe compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak.ResultsThirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak (n = 10,263) in contrast to before the outbreak period (n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups.ConclusionThere was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.     

Impact of COVID-19 on an infection prevention and control program,Iowa 2020-2021

BackgroundThe COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions.MethodsWe retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period.ResultsA total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges.ConclusionsOur IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.