• COVID-19
• 2013-2022close
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Abstract Background Coronaviruses pose a serious threat to global health as evidenced by Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and COVID-19. SARS Coronavirus (SARS-CoV), MERS Coronavirus (MERS-CoV), and the novel coronavirus, previously dubbed 2019-nCoV, and now officially named SARS-CoV-2, are the causative agents of the SARS, MERS, and COVID-19 disease outbreaks, respectively. Safe vaccines that rapidly induce potent and long-lasting virus-specific immune responses against these infectious agents are urgently needed. The coronavirus spike (S) protein, a characteristic structural component of the viral envelope, is considered a key target for vaccines for the prevention of coronavirus infection. Methods We first generated codon optimized MERS-S1 subunit vaccines fused with a foldon trimerization domain to mimic the native viral structure. In variant constructs, we engineered immune stimulants (RS09 or flagellin, as TLR4 or TLR5 agonists, respectively) into this trimeric design. We comprehensively tested the pre-clinical immunogenicity of MERS-CoV vaccines in mice when delivered subcutaneously by traditional needle injection, or intracutaneously by dissolving microneedle arrays (MNAs) by evaluating virus specific IgG antibodies in the serum of vaccinated mice by ELISA and using virus neutralization assays. Driven by the urgent need for COVID-19 vaccines, we utilized this strategy to rapidly develop MNA SARS-CoV-2 subunit vaccines and tested their pre-clinical immunogenicity in vivo by exploiting our substantial experience with MNA MERS-CoV vaccines. Findings Here we describe the development of MNA delivered MERS-CoV vaccines and their pre-clinical immunogenicity. Specifically, MNA delivered MERS-S1 subunit vaccines elicited strong and long-lasting antigen-specific antibody responses. Building on our ongoing efforts to develop MERS-CoV vaccines, promising immunogenicity of MNA-delivered MERS-CoV vaccines, and our experience with MNA fabrication and delivery, including clinical trials, we rapidly designed and produced clinically-translatable MNA SARS-CoV-2 subunit vaccines within 4 weeks of the identification of the SARS-CoV-2 S1 sequence. Most importantly, these MNA delivered SARS-CoV-2 S1 subunit vaccines elicited potent antigen-specific antibody responses that were evident beginning 2 weeks after immunization. Interpretation MNA delivery of coronaviruses-S1 subunit vaccines is a promising immunization strategy against coronavirus infection. Progressive scientific and technological efforts enable quicker responses to emerging pandemics. Our ongoing efforts to develop MNA-MERS-S1 subunit vaccines enabled us to rapidly design and produce MNA SARS-CoV-2 subunit vaccines capable of inducing potent virus-specific antibody responses. Collectively, our results support the clinical development of MNA delivered recombinant protein subunit vaccines against SARS, MERS, COVID-19, and other emerging infectious diseases.

Abstract Chikungunya virus (CHIKV) causes an acute febrile illness usually accompanied by severe polyarthralgia and polyarthritis. Previous studies have shown that older age, female gender, and some comorbid conditions are associated with chronic CHIKV arthritis. However, the factors associated with acute arthralgia and arthritis are not well known. Thus, we studied the clinical manifestations associated with acute peripheral joint involvement in a group of CHIKV patients from Puerto Rico. Patients with a history of fever for < 7 days evaluated at the emergency department of a university-based hospital were tested for several pathogens including CHIKV. All patients with laboratory-positive CHIKV infection were studied. Demographic features, clinical manifestations, and comorbidities were determined. Patients with and without peripheral joint involvement were compared using bivariable and multivariable analyses. In total, 172 patients with CHIKV fever were evaluated; 52.9% were women. The mean (standard deviation) age was 21.1 years (19.3). Peripheral arthralgia and/or arthritis were seen in 156 (90.7%) patients. In the multivariable analysis adjusted for age and gender, peripheral joint involvement was associated with myalgia (odds ratio [OR] = 4.65, 95% confidence interval [CI] = 1.48–14.72), back pain (OR = 16.77, 95% CI = 3.07–313.82), ocular pain (OR = 8.88, 95% CI = 1.65–165.19), headache (OR = 3.63, 95% CI = 1.06–12.53), anorexia (OR = 5.68, 95% CI = 1.87–18.97), and nausea (OR = 6.88, 95% CI = 2.05–31.49). In conclusion, in this population of patients with acute CHIKV infection, peripheral joint involvement was associated with myalgia and back pain as well as nonmusculoskeletal manifestations such as headache, ocular pain, anorexia, and nausea.

Abstract Background To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP. Methods 102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping. Results Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-Rfocus: 1.0 [0.4 to 1.6]; CAMS-Raccept: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping. Discussion Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).

From March 2020 through March 2021, researchers monitored three San Francisco Bay Area transit agencies: two large – Alameda-Contra Costa Transit District (AC Transit), Valley Transportation Authority (VTA); and one small – Tri Delta Transit. As the lockdown was imposed in response to the COVID-19 pandemic, white-collar commuters, students, and the elderly stopped using public transit. Initially, ridership fell 90 percent, and then over the year slowly climbed to less than 50 percent for AC Transit and VTA, and to around 60 percent for Tri Delta Transit. The pace of recovery was not steady as ridership declined during protests in June 2020, during fare reinstatements in autumn 2020 and during the second COVID-19 wave in winter 2020-21. Agencies’ responses to the pandemic consisted of three parts: 1) maintaining health and safety of their employees; 2) minimizing COVID risk for their riders by keeping buses clean and enabling social distancing through capping the number of passengers on buses; and 3) changing their service. There was a direct relationship between the socioeconomic status of the population and transit ridership during the year studied. Higher ridership was observed in low-income areas with a high percentage of Latino, Black and Asian populations. These are generally renters, who do not have a car, but have to go to work either because they are essential workers and/ or are undocumented immigrants who cannot afford staying jobless. On the other hand, in wealthy areas of the Bay Area transit activity all but disappeared.

No abstract available Keywords: COVID-19; Diabetes; Evidence-based practice; Renin-angiotensin system; Risk; SARS-CoV-2; Therapy.

COVID-19 is truly an unprecedented event, forcing nearly four billion people into isolation, social distancing, and requiring people to rigorously follow public health measures such as frequent hand washing and indoor face-covering. People around the world have spent months staying home-bound, enduring significant financial, social, and emotional costs. They have been feeling anxious, irritable, afraid, and ambivalent in the wake of an invisible, pervasive, and potent pandemic. A strength focus can help us mitigate unwarranted or excessive negative emotions engendered by maintaining social distancing. This paper posits that by using our strengths, we can enhance our psychological immunity through pragmatic actions to enhance our daily wellbeing. More importantly, we can reframe and reappraise challenges to build perspective in dealing with global crises such as pandemics and disasters. Strengths expressed through pragmatic actions can boost our coping skills as well as enhance our wellbeing. Consistent with the zeitgeist of our times-equity, social justice, digital connections, the paper offers easily implemented, concrete actions using character strengths in adaptive ways to reduce the likelihood that social distancing will result in overwhelming anxiety, lack of structure or stimulation, and demoralization.

Abstract Coronavirus disease-2019 (COVID-19) has been reported to cause significant morbidity in adults, with reportedly a lesser impact on children. Cardiac dysfunction has only been described in adults thus far. We describe 3 cases of previously healthy children presenting with shock and COVID-19–related cardiac inflammation. (Level of Difficulty: Intermediate.)

Purpose The purpose of this study was to report the adverse effects of the COVID-19 pandemic on the clinical outcomes of infectious keratitis in South India. Methods Two hundred fifty-eight patients presented with infectious keratitis at 6 tertiary care centers when strict travel restrictions were in place from March 24 to May 31, 2020. Case records were collected retrospectively and analyzed for demographics, type of initial treatment, length of delay in presentation, microbiological diagnosis, clinical course, and final treatment outcome. Results The mean age of the patients was 49.2 years, with most of them (61.2%) being male. Forty-one patients (15.9%) did not receive any treatment for at least a week after the onset of symptoms. One hundred eight patients (41.9%) presented with severe ulcer (32 had a frank perforation). Resolution of the infection was achieved only in 103 patients (45.6%). A total of 90 patients (39.8%) with ulcers had a perforation, yet only 29 patients (32.2%) could receive keratoplasty because of the unavailability of donor tissues. At the end of 6-month follow-up, 47 patients had anatomical failure (loss of globe) and 12 additional patients had functional failure (total permanent vision loss). Conclusions Delay in presentation and acute shortage of donor corneal tissues for emergency keratoplasty because of the COVID-19 pandemic had a grave impact, resulting in irreversible blindness in a significant number of patients.

The basic reproduction number, R0, determines the rate of spread of a communicable disease and therefore gives fundamental information needed to plan public health interventions. Using mortality records, we estimated the rate of spread of COVID-19 among 160 counties and county-aggregates in the USA at the start of the epidemic. We show that most of the high among-county variance is explained by four factors (R2 = 0.70): the timing of outbreak, population size, population density, and spatial location. For predictions of future spread, population density and spatial location are important, and for the latter we show that SARS-CoV-2 strains containing the G614 mutation to the spike gene are associated with higher rates of spread. Finally, the high predictability of R0 allows extending estimates to all 3109 counties in the conterminous 48 states. The high variation of R0 argues for public health policies enacted at the county level for controlling COVID-19. Ives and Bozzuto estimate the spread rate of COVID-19 in the USA at the start of the epidemic, extrapolating values of R0 for 3109 counties during the period before measures were taken to reduce the spread. Most of predictive variation in county-level values of R0 is explained by population density and spatial location, with differences among locations associated with differences among strains of SARS-CoV-2.