Category: Corona Virus

Introduction

Healthcare workers (HCWs) are the foundation of the response to a pandemic. Also termed as frontline workers, not only are they at a health risk but also suffer from emotional and psychological stress.

The objective of the study was to determine the emotional impact of novel coronavirus on healthcare workers.

An online survey was completed by 239 HCWsfrom five different countries during the peak of the coronavirus disease 2019 (COVID-19) outbreak amidst the lockdown. Their feelings and concerns as well as the safety measures they adopted were identified.

The response rate was 100%. Most of the respondents were 20-40 years old (85.36%)and working as doctors (73.22%); 44.77% were working at middle grade. The majority felt confused (19.67%), whereas others felt stressed/overworked (17.15%), unhappy (16.74%), scared (13.81%), nervous (13.39%), motivated (8.79%), and privileged (5.86%). A few felt pressurized to perform their duty (4.6%), and 69.87% felt that it was their moral obligation to continue their duty, whereas 13.39% felt administrative pressure for the same. Of the respondents, 53.97% feared transferring the disease to their family and friends, while others feared the lack of personal protective equipment (PPE) (13.39%). According to the majority of the respondents (25.94%), support from family and friends had them going through the crisis. The most common safety measure adopted by the HCWs was strict hand hygiene (43.51%). The HCWs (28.87%) felt that adequate and easy access to PPE would have helped them better during the pandemic.

Healthcare institutions are responsible for protecting HCWs or frontline workers during pandemics so they can continue with their duty. From our study, we have concluded that simple protective measures as uninterrupted and easy access to PPE would have helped HCWs deal with their stress and concerns.

Since the severe acute respiratory syndrome (SARS) outbreak in 2003, the 21st century has seen numerous pandemics [1]. Epidemiologically speaking, these infections have no borders to spread because of extensive international travel [2], hence infecting huge numbers all around the globe.

Similarly, the year 2020 has been faced with a new pandemic starting in December 2019 in Wuhan, China, as unusual pneumonia caused by a new coronavirus [3,4]. This is the third outbreak caused by a coronavirus, the first and second being SARS and Middle East respiratory syndrome (MERS), respectively. The novel coronavirus 2019 is officially named SARS-CoV-2 [3]. It was declared a global emergency of international concern by the World Health Organization (WHO) on January 30, 2020 [3].

As of April 28, 2020, the total number of confirmed cases of the disease has been 2,954,222, with 202,597 deaths globally [5]. On the other hand, China alone has had 82,875 confirmed cases and 4,633 deaths as of May 2, 2020 [6].

When the pandemic gained global attention, a sudden decline in personal protective equipment (PPE) supplies [7], startling media reports, a huge influx of patients into hospitals, and a shortage of utilities secondary to bulk buying in lieu of an impending crisis and comparison with previous Coronaviridae outbreaks lead to uncertainty, vulnerability, panic, fear, distress, anger, and feelings of loss of control. Then, social distancing and finally a lockdown were set in place, which made coping with the pandemic even more difficult as peoples financial circumstances changed.

As with any other pandemic, there is a dual effect seen with this virus; not only is there fear and panic in the population but also an increased burden on the healthcare system including healthcare workers (HCWs) [2]. As the experience with SARS showed that HCWs were the most infected with high mortality [1,8-10], fear and uncertainty are markedly present among the HCWs. Other feelings varied from anxiety, to stress, to frustration, to stigmatization [3,11]. Frontline workers were relocated to different departments and were asked to work in different institutions as a part of task force reassignment to deal with the suspected surge, as was previously observed during the SARS outbreak [11].

Frequently changing guidelines on infection control procedures and public health recommendations stirred confusion and anxiety [11].

We wanted to study the emotional impact of novel coronavirus 2019 on HCWs and how they chose to address these concerns.

This prospective, cross-sectional study was conducted using an open online survey filled by HCWs from hospitals caring for COVID-19 patients in the UK, the USA, Pakistan, Libya, and Saudi Arabia. The survey was conducted from April 23, 2020, to May 18, 2020. HCWs from all fields were eligible for participation. The survey was completely anonymous, and responses were kept confidential. The survey was completed by 239 participants. The work has been reported in line with the Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) criteria [12].

We aimed at assessing the feelings of HCWs during the SARS-CoV-2 pandemic, the reason behind their feelings, how they addressed their concerns, and their suggestions.

Demographic data including age, healthcare category, grade, and department (for physicians and nurses) were recorded and separately used to analyze risk factors.

Data analysis was done using the SPSS software version 25.0 (IBM Corp., Armonk, NY, USA).

Of the 239 participants, the completion rate was 100%. A total of 204 (85.36%) respondents were between 20 and 40 years, 33 (13.81%) between 41 and 60 years, and two (0.84%) more than 60 years (Figure 1, Table 1).

Of the 239 respondents, 175 (73.22%) were physicians, 32 (13.39%) were nurses, 14 (5.86%) were operating department practitioners (ODPs), nine (3.77%) were administrative staff, three (1.26%) were laboratory/radiology personnel, and two (0.84%) each of paramedics, clinical assistants, and pharmacists (Figure 2, Table 2).

Most of the HCWs belonged to the middle grade (107 (44.77%)), whereas junior and senior grades constituted 63 (26.36%) and 69 (28.87%) of the respondents, respectively (Figure 3, Table 3).

Physicians and nurses were optionally required to record their department. Out of the 175 physicians,163 answered this question, and the majority of them (55) belonged to general surgery, followed by general practitioners (13), anesthetists (10), and orthopedic surgeons (9). Seven physicians were from medicine;six each from pediatrics, accident and emergency, and otolaryngology;five each from nutrition and radiology; four each from gynecology/obstetrics, dermatology, and neurosurgery; three each from urology, intensive care, and dentistry;two each from pathology, nephrology, and maxillofacial; and one each from infectious diseases, ophthalmology, endocrinology, cardiology, neurology, elderly care, vascular surgery, physical medicine and rehabilitation, and public health.

The majority of the respondents felt confused (47 (19.67%)) during the pandemic. Forty-one (17.15%) felt stressed/overworked, 40 (16.74%) felt unhappy, and 33 (13.81%) felt scared. Other feelings included feeling nervous(32 (13.39%)), being motivated (21 (8.79%)), being privileged (14 (5.86%)), and feeling pressurized to perform duty (11 (4.60%)) (Figure 4, Table 4).

Of the HCWs, 68.87% (167) felt it to be their moral obligation to continue duty, while others felt administrative pressure (32 (13.39%)) for continuation. Twenty-five (10.46%) HCWs chose financial incentives as the main reason to continue working during the pandemic, and 15 (6.28%) had other reasons (Figure 5, Table 5).

Fear of spreading the disease to their family and friends was prevalent among the HCWs. Overall, 129 (53.97%) respondents chose this as their major concern. Lack of personal protective equipment (PPE) bothered 32 (13.39%) of the respondents. The HCWs were concerned about contracting the disease (17 (7.11%)), lack of established guidelines (11 (4.60%)), lack of a vaccine (8 (3.35%)), inadequate screening (8 (3.35%)), lack of knowledge about the virus or disease (7 (2.93%)), being overworked/understaffed (7 (92.93%)), and lockdown (7 (2.93%)). The lack of established treatment for the disease caused unrest among five (2.09%) of the respondents. Others feared media reports (4 (1.67%)), conflict among staff members (2 (0.84%)), and improper isolation (2 (0.84%)) (Figure 6, Table6).

The responses to how HCWs addressed their concerns included support from family and friends (62 (25.94%)), teamwork (47 (19.67%)), senior support (37 (15.48%)), established hospital guidelines (31 (12.97%)), relatively small number of patients testing positive (20 (8.37%)), hospital meetings (15 (6.28%)), support groups (5 (2.09%)), hospital psychiatry support (2 (0.84%)), and ongoing HCW benefits (1 (0.42%)). A total of 19 respondents had other ways to help them out during the crisis (Figure 7, Table 7).

Strict hand hygiene was adopted by 104 (43.51%) HCWs as a safety measure. Thirty-eight (15.90%) considered all patients as carriers, 32 (13.39%) adopted strict PPE use, 26 (10.88%) resorted to self-isolation/social distancing, and 18 (7.53%) had separate scrubs for hospital duty. Seven (2.93%) HCWs went on leave, and six (2.51%) strictly followed updates on the disease. Eight of them adopted other measures (Figure 8, Table 8).

When asked what would have helped them better deal with the situation, 69 (28.87%) responded with adequate and easily accessible PPE, and 67 (28.03%) thought better-established guidelines on screening, isolation, and treatment should have been in place. Thirty-seven (15.48%) suggested strict hand hygiene monitoring; for 33 (13.81%), a vaccine or treatment would have been reassuring, while eight ( 3.35%) wished for a financial incentive, seven (2.93%) asked for a compensatory time off, four (1.67%) suggested a voluntary opt-out of duty, and three (1.26%) carved for a little appreciation from authorities. Eleven (4.60%) had other suggestions (Figure 9, Table 9).

Our survey including 239 participants revealed a high prevalence of confusion and stress/being overworked in HCWs involved in the care of COVID-19 patients (19.67% and 17.15%, respectively). This is comparable to studies done during the SARS outbreak [13]. During a pandemic, HCWs are prone to a multitude of feelings [3,11]. Feeling unhappy, scared, nervous, motivated, privileged, and pressurized to perform duty were reported by 16.74%, 13.81%, 13.39%, 8.79%, 5.86%, and 4.60%, respectively. Previous studies during the SARS pandemicreported similar outcomes [3]. The long-term psychological implications of a pandemic have been studied with SARS and need to be kept in mind and assessed during the current pandemic [14,15]. HCWs should be trained in dealing with stress during an infectious outbreak to optimize their response and efficiency.

Doctors formed the majority of the respondents (73.22%), followed by nurses (13.39%). Most of the respondents were between 20 and 40 years of age (85.36%), and 44.77% of them were in the middle grade of their careers.

Another important aspect highlighted by our study was that 69.87% of the HCWs felt motivated to perform their duty during the pandemic despite all the fear, anxiety, and confusion. Because of their direct contact with COVID-19 patients and the fact that this disease has cross communicability [3], 53.97% of the HCWs feared transferring the disease to their family members and friends. Our survey also found out that support from family and friends (25.94%) and teamwork (19.67%) helped HCWs continue to perform their duty despite mounting pressure and fear.

As with any other infectious disease, hand hygiene was opted for by a mere 43.51% of the respondents as the primary safety measure, the numbers not as significant as would have been expected from HCWs. We want to stress the need for further infection control training and strict hand hygiene compliance monitoring for effective infection control and prevention. We would like to suggest that future pandemic response training should include infection control training as an integral part.

Our survey identified that measures as simple as adequate and easily accessible PPE would have made a huge difference in terms of reassuring HCWs as mentioned by 28.87% of the respondents. As observed initially, the sudden shortage of PPE was a rather important factor in causing emotional distress among HCWs as was noted earlier during previous infection outbreaks [7,11]. On the other hand, an almost equal number of respondents (28.03%) thought it would have been better if there were well-established guidelines on screening, isolation, and treatment of COVID-19 patients. Dealing with an unknown pathogen and a rather unfamiliar disease pattern makes it difficult, but diverting resources toward research, as observed during the coronavirus pandemic, was of paramount importance.

This survey demonstrated the emotional impact of SARS-CoV-2 on HCWs. The mental and emotional well-being ofHCWs is of paramount significance if they were to work efficiently. It is the responsibility of healthcare institutions to safeguard their HCWs and provide them with the means to cope with stress and anxiety. Working under stressful conditions during an infectious outbreak would lead to long-term psychological morbidity in HCWs, as previously identified.

Read more:

The Emotional Impact of Novel Coronavirus on Healthcare Workers: A Cross-Sectional Study - Cureus

Israel on Sunday saw over 10,000 new coronavirus cases diagnosed, the highest number since April 4, according to Health Ministry data released Monday.

According to the latest figures, 10,202 out of the 29,681 tests conducted on Sunday came back positive, putting the positivity rate at 38.9 percent.

The ministry also reported that 168 people were in serious condition a rise of 95% from last week with 37 of them classified as critical.

The reproduction number (R) continued to fluctuate, standing at 1.32 as of Monday morning.

Earlier in the month it stood at 1.52. The R figure is based on rates from ten days earlier, and it measures how many people each coronavirus carrier infects on average, with any number above 1 meaning the spread of COVID-19 is increasing.

Get The Times of Israel's Daily Editionby email and never miss our top stories

It began to rise above 1 in mid-May, having stayed below that threshold for nearly two months.

Family members visiting a family member at the coronavirus ward of Ziv Medical Center in the northern city of Safed on February 15, 2022. (David Cohen/Flash90)

The death toll stood at 10,908 as of Monday morning, including 13 fatalities over the past week.

While Israel has seen rising infection numbers for a few weeks, an increase in seriously ill patients presents a real concern as the country deals with the spread of the new variant BA.5.

Health Ministry officials told hospital directors on Monday that they should begin preparations for the reopening of dedicated COVID-19 wards.

The rise in cases has also led to officials mulling the reintroduction of certain restrictions, with health officials set to discuss a return to mandatory indoor masking and the possibility of authorizing COVID-19 vaccines for infants and preschoolers.

Israel officially lifted the indoor mask mandate on April 24, scrapping one of the few remaining coronavirus restrictions that were still in place more than two years into the pandemic.

Travelers wearing protective face masks at Ben Gurion Airport, on August 5, 2021. (Avshalom Sassoni/Flash90)

According to an unnamed Health Ministry official cited by the Kan public broadcaster on Sunday, a decision on renewing the measure will be made next week.

Since masking rules were first imposed in April 2020 and before they were eased a couple of months ago, Israelis were required to wear face coverings indoors for all but 10 days in June last year, when the mandate was briefly lifted before being swiftly brought back amid burgeoning cases at the time.

Additionally, officials will also consider authorizing COVID-19 vaccines for the youngest children after US regulators on Fridaygave their approval for the first shots for infants and preschoolers.

According to the Ynet news site, the Health Ministry will discuss the matter at a meeting on Tuesday.

It's not (only) about you.

Supporting The Times of Israel isnt a transaction for an online service, like subscribing to Netflix. The ToI Community is for people like you who care about a common good: ensuring that balanced, responsible coverage of Israel continues to be available to millions across the world, for free.

Sure, we'll remove all ads from your page and you'll gain access to some amazing Community-only content. But your support gives you something more profound than that: the pride of joining something that really matters.

You're a dedicated reader

Were really pleased that youve read X Times of Israel articles in the past month.

Thats why we started the Times of Israel ten years ago - to provide discerning readers like you with must-read coverage of Israel and the Jewish world.

So now we have a request. Unlike other news outlets, we havent put up a paywall. But as the journalism we do is costly, we invite readers for whom The Times of Israel has become important to help support our work by joining The Times of Israel Community.

For as little as $6 a month you can help support our quality journalism while enjoying The Times of Israel AD-FREE, as well as accessing exclusive content available only to Times of Israel Community members.

Thank you, David Horovitz, Founding Editor of The Times of Israel

Go here to see the original:

Israel sees over 10,000 new coronavirus cases, highest daily number since April - The Times of Israel

The latest updates in the coronavirus pandemic for Monday, June 20, 2022.

INDIANAPOLIS Here are Monday's latest updates on the coronaviruspandemic, including the latest news on COVID-19 vaccinations and testing in Indiana.

Registrations for the vaccineare now open for Hoosiers 5 and older through the Indiana State Department of Health. This story will be updated over the course of the day with more news on the COVID-19 pandemic.

US opens COVID vaccine to little kids; shots begin this week

U.S. health officials have opened COVID-19 vaccines for infants, toddlers and preschoolers the last group without the shots.

The head of the Centers for Disease Control and Prevention announced the decision Saturday, hours after an advisory panel voted unanimously that coronavirus vaccines should made available to children as young as 6 months.

The Biden administration has been gearing up for the start of the shots early this week.

Millions of doses have been ordered for distribution to doctors, hospitals and community health clinics around the country.

CDC map shows Dubois at 'high risk,' 20 other Indiana counties at 'medium' risk

On Monday, June 20, 2022, Dubois County was listed on the CDC data map as having a "high" community risk of spreading COVID-19, while 20 other counties (Benton, Blackford, Carroll, Clark, Clinton, Crawford, Delaware, Elkhart, Floyd, Fountain, Harrison, Kosciusko, Lawrence, Orange, Randolph, Scott, Shelby, Tippecanoe, Washington and White) were listed as "medium" risks.

Latest US, world numbers

There have been more than 86.24 million confirmed cases of COVID-19 in the United States as of 6 a.m. ET Monday, according to Johns Hopkins University. There have been more than 1.013 million deaths recorded in the U.S.

Worldwide, there have been more than 538.97 million confirmed coronavirus cases with more than 6.318 million deaths and more than 11.6 billion vaccine doses administered.

For most people, the coronavirus causes mild or moderate symptoms. For some, especially older adults and people with existing health problems, it can cause more severe illness like pneumonia, or death.

White House offering additional 8 free COVID-19 tests to public

The government website for people to request free COVID-19 at-home tests from the U.S. government is now accepting a third round of orders.

The White House recently announced that U.S. households can request an additional eight free at-home tests to be shipped by the U.S. Postal Service.

President Joe Biden committed in January to making 1 billion tests available to the public free of charge, including 500 million available through covidtests.gov. But just 350 million of the amount available for ordering online have been shipped to date to addresses across the continental U.S., its territories and overseas military bases, the White House said.

People who have difficulty getting online or need help placing an order can call 1-800-232-0233 for assistance.

The third round brings to 16 the total number of free tests available to each U.S. household since the program started earlier this year. Households were eligible to receive four tests during each of two earlier rounds of ordering through the website.

2nd COVID-19 booster shot available to Hoosiers 50 and up

The Indiana Department of Health announced that Hoosiers age 50 and older, as well as those 12 and older with weakened immune systems, are now eligible to receive a second mRNA COVID-19 booster shot at least four months after their first booster dose.

The Centers for Disease Control and Preventionrecommended the extra shot as an option but stopped short of urging that those eligible rush out and get it right away.

The IDOH is advising vaccine providers to begin administering second boosters of the Moderna and Pfizer vaccines to people who qualify.

The CDC also says that adults who received a primary vaccine and booster dose of the Johnson & Johnson vaccine at least four months ago may now receive a second booster dose of either mRNA vaccine.

You can find a vaccine location at ourshot.in.gov or by calling Indiana 211 (866-211-9966). Appointments are recommended, but many sites do accept walk-ins.

Read the original here:

Indiana coronavirus updates: US opens COVID vaccine to little kids; shots begin this week - WTHR

Patient deaths: 1,013,413

Total vaccine doses distributed: 758,129,055

Patients whove received the first dose: 259,198,178

Patients whove received the second dose: 221,924,152

% of population fully vaccinated (both doses, not including boosters): 66.8%

% tied to Omicron variant: 100%

% tied to Other: 0%

Here is the original post:

Coronavirus Omicron variant, vaccine, and case numbers in the United States: June 20, 2022 - Medical Economics

In a recent study posted to the medRxiv* preprint server, researchers assessed whether non-invasive estimation of the ratio of arterial oxygen partial pressure (PaO2) to the fractional inspired oxygen (Fi O2), i.e., the P/F ratio could measure overt and occult hypoxemia in coronavirus disease 2019 (COVID-19) patients.

Study: Overt and occult hypoxemia in patients hospitalized with novel coronavirus disease 2019. Image Credit:Dmitry Naumov/ Shutterstock

Modeling the risk of adverse COVID-19 outcomes has been an area of intense research. Hypoxemia markers could serve as robust predictors of adverse disease outcomes, given that progressive hypoxemia reflects clinical deterioration in COVID-19. Oxygen saturation (SpO2) using pulse oximetry and the oxygen flow rate are the most commonly featured markers of hypoxemia.

Most studies have used SpO2 in their models without including oxygen supplementation; however, the National Early Warning Score (NEWS) models incorporate oxygen supplementation irrespective of the flow rate. Therefore, the resulting scores do not invariably reflect the severity of hypoxemia. Nonetheless, these factors do not limit the P/F ratio.

The authors previously described a non-invasive estimation of P/F ratios (ePFR) from oxygen dissociation curves for a cohort of non-intubated hospitalized patients. They believed that P/F ratios from these models might be a valid surrogate for overt hypoxemia. Importantly, pulse oximetry readings were found to have racial bias resulting in occult hypoxemia, viz., undiagnosed arterial desaturation at thrice the frequency in Black patients relative to White patients. Therefore, the authors speculate that studying ePFR distributions by race might reveal occult hypoxemia.

In the present study, researchers identified a cohort of adults with hospital encounters for acute COVID-19 at the University of Virginia (UVA) medical center and two hospitals affiliated with Emory University. UVA medical center serves a rural and White population, and Emory sites serve the urban and primarily Black population. There were 1172 hospital encounters at the UVA due to COVID-19, and the final cohort at the UVA comprised 1100 hospital encounters between March 2020 and February 2021.

There were over 12,700 hospital encounters at Emory sites by December 2021, and a third (4219) of them were randomly sampled. The team queried the data warehouse to collect 1) baseline risk predictors such as age, race, sex, weight, height, and Charlson comorbidity index (CCI), 2) all components of ePFR, sequential organ failure assessment (SOFA) score, NEWS, and SpO2/FiO2 (S/F) ratio, and 3) time of admission/transfer to intensive care unit (ICU) or death.

The primary outcome of the investigation was clinical deterioration, that is, transfer to ICU or in-hospital death. Adjusted odds ratios (AOR) were computed to determine the association of ePFR with clinical deterioration. The rise in area under receiver operating characteristics curves (AUROC) was measured when ePFR was added to a baseline risk model.

They also measured (for comparison) the rise in AUROC with the addition of SpO2, S/F ratio, NEWS, SOFA, and oxygen flow rate to the same baseline model. Race was used as a proxy for skin color, and racial disparities (non-Black vs. Black) in the empirical cumulative distribution functions (ECDFs) were estimated using the two-sample Kolmogorov-Smirnov test.

Evaluation of the construct validity of operational markers of hypoxemia in hypothetical clinical scenarios.Construct validity of any marker of hypoxemia is the extent to which that marker accurately reflects the clinical construct of hypoxemia. This figure examines the construct validity of five operational markers of hypoxemia (rows) in common clinical scenarios (columns). In each scenario (column), two records of a patients oxygenation are compared (Record A on left, Record B on right). The first row titled clinical acumen describes a clinically sensible conclusion that a clinician might draw by comparing the two records. For example, in Scenario 2, a clinician will likely conclude that the two records do not represent any meaningful change in the severity of hypoxemic respiratory failure (row 1, column 2). Rather, Record B (SpO2of 91% on 2LPM of oxygen) might simply reflect the fact that a clinician initiated supplemental oxygen in response to Record A (SpO2of 85% on room air). Each of the subsequent rows describes the conclusion based solely on comparing a particular marker of hypoxemia. For example, if one solely compared SpO2in Scenario 2 (row 2, column 2), the conclusion would be that Record A reflects significantly more severe hypoxemia than Record B (SpO2of 85% v/s 91%). Considering the varying range of each marker, we used the following cutoffs to determine a significantly more/less hypoxemia: any difference 1 for NEWS (range 0 to 5), any difference 2 for SpO2(range 85 to 100) and supplemental oxygen flow rate (range 0 to 15 LPM), and any difference 50 for S/F ratio (range 85 - 476) and P/F ratio (range 50 - 632). A cell is shaded green when there is agreement between the marker of hypoxemia and clinical acumen; and it is shaded red when there is disagreement. This figure illustrates the advantages of estimated P/F ratios over other markers it is the only marker to agree with clinical acumen in all scenarios. We were unable to conceptualize any scenario where P/F ratio would be inferior to other markers. (RA = Room Air; LPM = liters per minute)

Clinical deterioration was recorded in 177 patients (17%) at the UVA medical center and 791 (19%) at Emory sites. Overt hypoxemia independently predicted the primary outcome within 24 hours with an AOR of 0.99 for UVA subjects and 0.995 for Emory subjects. Adding ePFR to baseline risk models caused model discrimination with AUROC of 0.76 for UVA and 0.71 for Emory. This was better than adding SpO2 or oxygen flow rate to the baseline but similar to adding the S/F ratio.

Furthermore, ePFR outperformed the NEWS models at UVA and Emory sites. The authors observed the ECDFs were right-shifted in Black subjects relative to non-Black patients. This meant that Black patients had seemingly better oxygenation with greater SpO2, ePFR, and S/F ratios than non-Black patients. Still, worse outcomes were evident in Black patients for comparable oxygenation levels.

When clinical deterioration was modeled for UVA subjects using race, SpO2, and other baseline predictors, they found that race was not a significant predictor. However, race was significantly a strong predictor when SpO2 was substituted with S/F ratio or ePFR in that model. Likewise, race was a significant predictor for Emory data when the primary outcome was modeled with S/F ratio or ePFR than with SpO2.

The study found that the P/F ratio had significant predictive validity for COVID-19 outcomes. They also noted that pathological hypoxemia could be hidden in Black patients. The ePFR-based model outperformed complex models like Sepsis-3 and NEWS in predicting clinical deterioration.

For comparable oxygenation levels, Black subjects were at an elevated risk of adverse outcomes than non-Black patients. This was indicative of the occult hypoxemia phenomenon that results in clinicians using lower FiO2 settings due to a falsely reassuring reading of SpO2 and thereby leading to worse (COVID-19) outcomes.

In conclusion, the P/F ratios accurately predicted the severity of overt hypoxemia, and ePFR might permit real-world statistical modeling of racial disparities in outcomes attributable to occult hypoxemia from pulse oximetry readings.

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.

Originally posted here:

Overt and occult hypoxemia in patients hospitalized with COVID-19 - News-Medical.Net

Mike Stucka USA TODAY NETWORK| Gonzales Weekly Citizen

Louisiana reported far fewer coronavirus cases in the week ending Sunday, adding 6,649 new cases. That's down 16.1% from the previous week's tally of 7,921 new cases of the virus that causes COVID-19.

Louisiana ranked 38th among the states where coronavirus was spreading the fastest on a per-person basis, a USA TODAY Network analysis of Johns Hopkins University data shows. In the latest week coronavirus cases in the United States decreased 0.7% from the week before, with 730,572 cases reported. With 1.4% of the country's population, Louisiana had 0.91% of the country's cases in the last week. Across the country, 15 states had more cases in the latest week than they did in the week before.

Ascension Parish reported 178 cases and zero deaths in the latest week. A week earlier, it had reported 181 cases and zero deaths. Throughout the pandemic it has reported 34,089 cases and 293 deaths.

Across Louisiana, cases fell in 34 parishes, with the best declines in Bossier Parish, with 292 cases from 644 a week earlier; in Jefferson Parish, with 659 cases from 928; and in Orleans Parish, with 612 cases from 831.

>> See how your community has fared with recent coronavirus cases

Within Louisiana, the worst weekly outbreaks on a per-person basis were in St. James Parish with 280 cases per 100,000 per week; De Soto Parish with 240; and Bossier Parish with 230. The Centers for Disease Control says high levels of community transmission begin at 100 cases per 100,000 per week.

Adding the most new cases overall were East Baton Rouge Parish, with 727 cases; Jefferson Parish, with 659 cases; and Orleans Parish, with 612. Weekly case counts rose in 26 parishes from the previous week. The worst increases from the prior week's pace were in Rapides, Lafayette and Ouachita parishes.

In Louisiana, 17 people were reported dead of COVID-19 in the week ending Sunday. In the week before that, 15 people were reported dead.

A total of 1,210,760 people in Louisiana have tested positive for the coronavirus since the pandemic began, and 17,373 people have died from the disease, Johns Hopkins University data shows. In the United States 86,246,101 people have tested positive and 1,013,413 people have died.

>> Track coronavirus cases across the United States

USA TODAY analyzed federal hospital data as of Sunday, June 19.

Likely COVID patients admitted in the state:

Likely COVID patients admitted in the nation:

Hospitals in 29 states reported more COVID-19 patients than a week earlier, while hospitals in 25 states had more COVID-19 patients in intensive-care beds. Hospitals in 31 states admitted more COVID-19 patients in the latest week than a week prior, the USA TODAY analysis of U.S. Health and Human Services data shows.

The USA TODAY Network is publishing localized versions of this story on its news sites across the country, generated with data from Johns Hopkins University and the Centers for Disease Control. If you have questions about the data or the story, contact Mike Stucka at mstucka@gannett.com.

More here:

Ascension Parish reported 178 additional COVID-19 cases this week - Weekly Citizen

People wear masks as they walk near Ruins of St. Pauls, following the coronavirus outbreak in Macau, China February 5, 2020. REUTERS/Tyrone Siu

Register

June 19 (Reuters) - Macau's government said on Sunday it would begin mass COVID-19 testing for all residents after locally transmitted coronavirus cases were found overnight.

Local media in the gambling hub said 12 locally transmitted COVID-19 cases were found.

Various control measures have been taken, including closing schools, parks, museums and sports facilities starting on Sunday, to reduce crowds gathering, the government said.

People leaving Macau must also hold a certificate of negative nucleic acid test results within 24 hours for customs clearance, it said.

Register

Reporting by Donny Kwok; Editing by Tom Hogue

Our Standards: The Thomson Reuters Trust Principles.

Go here to see the original:

Macau to begin mass COVID testing on Sunday amid locally transmitted cases - Reuters

Long COVID continues to offer more questions than answers 27 months into the coronavirus pandemic, though researchers are slowly gaining a better understanding.

Long-term effects from SARS-CoV-2 infection, known more commonly as long COVID, has been the topic of more than 1,650 papers published in the National Library of Medicine since 2020.

When asked about long COVID, most physicians will offer up their experience and/or research with a caveat -- more research is needed to know for sure.

Were really just starting to work this whole thing out, said Dr. Matthew Sims, director of infectious disease research at Beaumont Health. Its complicated, its confusing. To be honest, I think were going to find that long COVID is the same sort of problem we see with other things and all the research thatll end up being done on long COVID, because its such a big issue, may help other diseases like fibromyalgia or chronic fatigue syndrome, that are really hard to figure out right now. We dont know.

Researchers have made some progress however. Below are some common questions and answers related to long COVID.

What is long COVID?

The typical definition of long COVID is long-term symptoms from SARS-CoV-2 that might be experienced weeks, months or even years after primary infection.

As for specific symptoms that linger, those vary.

A recent survey conducted by the Center for Health and Research Transformation (CHRT) at the University of Michigan found breathing issues were the most common ongoing symptom, followed by loss or distorted sense of smell or taste, and lingering anxiety, depression, or other mental health issues.

Other common symptoms were nervous system symptoms, neurologic problems, diabetes, heart problems, kidney damage, and fatigue.

The Cover Michigan Survey is a public opinion telephone and online survey that includes a random sample of Michigan adults. Its results were analyzed by CHRT staff, who said many of their findings were supported by national data and additional research.

I like to think this is sort of the tip of the iceberg with long COVID, because everything about this virus and this pandemic and this disease is so new and every day were still learning more stuff, said Melissa Riba, director of research and evaluation at CHRT.

In July 2021, long COVID became a disability under the Americans with Disabilities Act. An individualized assessment is necessary to determine whether a persons long COVID condition substantially limits them.

How common is it?

The Cover Michigan Survey found more than one in three Michiganders who reported a COVID-19 diagnosis identified themselves as a COVID long hauler. While the sample size was limited -- 138 individuals with COVID, of which 48 reported long COVID -- it matched or followed trends found in other studies.

Stretching globally, the University of Michigan School of Public Health analyzed 50 studies and more than 1.6 million people and found the prevalence of long COVID to be around 43%.

With the overall rates, if you look at most of the literature, it generally falls among the range of between 25% and 43%, with most sources falling within a more narrow range between like 30% to 35%, said Jonathan Tsao, a project manager at CHRT.

Its not yet clear which demographics are more or less susceptible to long COVID, though researchers are gaining clarity on that issue.

The risk factors for getting long COVID are somewhat similar to those people who are at increased risk for severe disease, said Dr. Liam Sullivan, an infectious disease specialist at Spectrum Health. That being said, theres a lot of people whove had mild COVID cases who have had issues with long COVID as well. So thats not really been fully delineated yet.

A Swedish study of more than 205,000 COVID patients founds that 32% of those admitted to an ICU developed long COVID. Thats compared to 6% of those hospitalized but not placed into intensive care, and 1% of outpatients.

Other groups that have reported disproportionate levels of long COVID are women, individuals 40 to 54, and persons with preexisting conditions, according to a 2021 study conducted in California and published by the CDC.

In Michigan, CHRT found women were four times as likely to report long COVID, and diabetics were twice as likely, compared to their counterparts.

Does the vaccine offer protection against long COVID?

A study published last month in Nature Medicine used 2021 Veterans Affairs health records to assess potential vaccine-induced protection against long COVID. The St. Louis, Missouri study determined COVID vaccination reduced risk of long COVID by about 15%.

It was one of, if not the largest, study to date. Researchers looked at records from 34,000 vaccinated people with breakthrough infections, 113,000 non-vaccinated people who got COVID, and more than 13 million people who had not gotten COVID.

The study revealed no difference in specific lingering symptoms or the severity of symptoms.

Dr. Sullivan said you have to be careful extrapolating those results to the general population however, when the study population were veterans with an average age in their 60s with underlying risk factors.

Getting vaccinated doesnt eliminate your risk for long COVID, he said. You still have risk for long COVID; what is starting to probably become clear is the risk is probably lower and that people dont get quite as severe long COVID, but that question still has to be more fully answered.

Sullivan said he anticipates the results of a larger study being conducted by CDC and some partner universities to better define and understand the scope of long COVID.

Whatre the economic impacts of long COVID?

The latest Cover Michigan Survey found long haulers are more likely to be in a worse financial situation than a year ago, compared to those who recovered from COVID and those who never got infected.

Because long haulers may be unable to function at their pre-COVID capacity, they are more likely to take longer medical leave, work reduced hours, have their salary reduced, or quit their jobs, researchers found.

A national survey of more than 1,000 COVID patients found that 44% of workers experiencing long COVID reduced their weekly work hours. A majority of respondents said they needed to take medical leave due to long COVID symptoms.

Researchers who analyzed Michigans long COVID data said theres a need for further study on the impact of state-wide efforts to assist long haulers. They recommend:

By publishing its survey results, CHRT researchers said they hope to raise awareness among lawmakers and business leaders as to the prevalence of long haulers, as well as for individuals who are suffering and feeling like theyre alone with their long-term symptoms.

We want to raise an alarm, raise a flag to say hey, this is potentially going to be and could be a really big deal for policymakers, for the state, for the economy, for the health care system and we need to be prepared, Riba said.

If you have any COVID-19 questions that youd like answered, please submit them to covidquestions@mlive.com to be considered for future MLive reporting.

Read more on MLive:

11 counties in U.P., northern Michigan have high COVID-19 levels; CDC says, recommends masking

COVID therapeutics becoming more common: Michigan COVID data for Thursday, June 16

FDA advisors recommend vaccinating children under 5 against COVID

Novavaxs more traditional COVID vaccine could combat hesitancy, doc says

See more here:

Long COVID answers are coming into focus, slowly - MLive.com

The Chief Clinical Officer of the HSE has said he is "very concerned" about the rise in the number of people in hospital with, or because of, Covid-19.

It comes as 606 confirmed cases of Covid-19 were reported in the country's hospitals this morning.

As of 8am there were 153 more people in hospital with Covid today than there were last Monday.

There were 453 people with confirmed cases in hospital on Monday 13 June.

Speaking on RT's Today with Claire Byrne, Dr Colm Henry said the rise is largely driven by a sub-type of the Omicron variant.

"This sub-type enjoys what is called a growth advantage over previous sub-types and is now displacing it as the dominant variant here. It's about 100% of cases in Portugal and now over 70% here."

Dr Henry said that although it is much more transmissible, it does not seem to be more virulent or aggressive.

"While hospitalisations are going up, we are seeing ICU numbers steady which is of some assurance," he said.

"Those who previously had immunity from previous variants, be they Delta or otherwise, can get infected again but they are much less likely to get seriously ill."

'Not too late to get vaccinated'

Dr Henry said there has been an increase in outbreaks in nursing home settings and residential care facilities but "nothing like we saw when we peaked in March following the surge of Omicron cases with earlier sub-variants but nevertheless, we have seen a rise at our operational clinical meeting this morning".

There has also been a rise in cases among healthcare workers.

Dr Henry said they are hearing that "they are not particularly sick but because they test positive, it does have that impact on services".

There has also been a rise in hospital-acquired infections, Dr Henry said.

On vaccinations and hospital cases, Dr Henry said: "The harsh reality is that if you look at hospitalisations, 606 this morning, unfortunately over half have not received their booster and over a third haven't even got vaccinated in the first place."

He said it is not too late to get vaccinated and "people who are unvaccinated in the first place have no protection from serious illness, no protection from being hospitalised and going to ICU or worse. It's not too late for those people to get vaccinated".

Latest wave of infection was 'predictable'

Dr Gerald Barry, Assistant Professor of Virology at University College Dublin, said the rise in case numbers in hospitals is reflective of what is going on in the general population.

He told RT's Morning Ireland that we are experiencing a further wave of Covid-19 and while around half of the cases identified in hospital are 'incidental' - that is patients are in hospital for another reason - infections are being picked up due to the ongoing testing in hospital settings.

Dr Barry said that this wave of infection was predictable up to eight weeks ago and talk of the reintroduction of mandatory mask wearing now was like "closing the stable door when the horse had bolted".

We need your consent to load this rte-player contentWe use rte-player to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences

He said it was likely that we were close to the peak of the current wave and he couldnt be sure that a mandatory mask wearing order would have much impact at this stage.

Dr Barry said the public should have been informed a month ago that this wave was coming. He said the focus then should have been about mask wearing, increased antigen testing and people adjusting their behaviour, to help reduce the peak of infection.

He said the virus is still causing a huge burden on the general population and the Government and the HSE needed to be more proactive in their ongoing communication and response to help reduce that burden.

Meanwhile, Tnaiste Leo Varadkar has said the Government will be guided by public health advice on whether or not a mask mandate is reintroduced.

On the summer wave of Covid, he said he thinks we will get over this wave without the need to impose any new restrictions, but any decision on that will be guided by public health advice.

Current wave to last 'two or three weeks'

Professor of Experimental Immunology at Trinity College Dublin, Kingston Mills, said he does not think there is a public appetite for mask wearing but that if everybody was wearing masks, it would make an impact on the transmission of the virus.

He said that there needs to be an "all or nothing" approach and that Covid is not seasonal.

He said that the current 'mini wave' could go on for two or three weeks, but long term we cannot give up on vaccines and boosters.

Professor Mills told RT's Drivetime that the big problem with hospitals is that the system is being stressed; healthcare workers are being infected and this is putting pressure on other healthcare procedures that have to be reduced, such as elective procedures, which is impacting people who do not have Covid.

Amid concerns that new variants may evade the vaccines currently in use, Professor Mills said updated vaccines are being produced and if they are rolled out in the autumn, with the flu vaccine, they will be closer to the strain of the disease that is circulating.

He said that another wave could come in the autumn but it totally depends on the virus and its mutation.

Dr Eoghan De Barra, consultant in infectious diseases at Beaumont Hospital in Dublin, said for the first time in a long time he is seeing patients admitted because of Covid rather than incidental Covid, where they tested positive while in hospital for another reason.

Dr De Barra said it is largely immunocompromised people, who have had some level of vaccination.

"They're not as sick as in earlier waves but still needed hospital care," said Dr De Barra.

He said it was really hard to say if we have reached the peak of this wave.

"When I see very immunocompromised patients, who have been very careful over [the] past two years, come in with Covid, I suspect there is a very high level in the community because they're the real tip of the iceberg of infection," he said.

Link:

HSE 'concerned' over rise in Covid-19 hospital numbers - RTE.ie

The member countries of the World Trade Organization on Friday reached a limited agreement to ease intellectual property protections on coronavirus vaccines, aiming to boost the supply for poorer countries.

The measure would make it easier for manufacturers in developing countries to override patents on the vaccines and export them for sale in other lower-income countries.

But the agreement, the outgrowth of an ambitious patent waiver proposed nearly two years ago, is arriving far too late and is far too modest in scope to meaningfully affect global vaccine supply, experts said.

This doesnt really move us beyond the status quo in any significant way, said Mihir Mankad, a researcher who advises Doctors Without Borders in the United States on global health advocacy and policy issues.

A key limitation is timing. Production of Covid-19 vaccines by the major drug companies that invented them is now far outpacing demand. The primary obstacles suppressing vaccination rates in lower-income countries are challenges with distribution and getting shots in arms, not with supply itself.

The agreement does not apply to coronavirus tests and treatments, which experts said were the more urgent priorities at this point in the pandemic, and could see their global supply increased significantly by a relaxing of intellectual property protections.

In October 2020, with wealthy countries locking up orders for the Covid vaccines that would soon become available, India and South Africa drafted an ambitious waiver of intellectual property rights under the W.T.O.s agreement on trade-related intellectual property rights, known as TRIPS.

A year ago, with poorer countries still facing severe vaccine shortages, the Biden administration came out in support of the proposal. The move was a significant departure from decades of U.S.-led opposition to easing intellectual property rules on medicines.

Katherine Tai, the United States Trade Representative, heralded Fridays deal as a concrete and meaningful outcome to get more safe and effective vaccines to those who need it most.

But experts said the proposal was weakened significantly over months of negotiations. They said they did not expect the final agreement to encourage manufacturers in developing countries to start producing Covid vaccines, in part because it does not address the trade secrets and manufacturing know-how that many producers would need.

The drug industry, which argues that robust intellectual property protections are crucial to innovation, has fiercely opposed the effort under the W.T.O. throughout the negotiations.

The industrys main lobbying group, the Pharmaceutical Research and Manufacturers of America, sharply criticized Fridays agreement. Stephen J. Ubl, the groups head, called it one in a series of political stunts and said it wont help protect people against the virus. He noted that the industry had already produced more than 13 billion Covid vaccine doses.

James Love, who leads Knowledge Ecology International, a nonprofit focused on intellectual property in medicine, said Fridays agreement falls far short of a patent waiver, as the proposal before the W.T.O. was originally envisioned.

It may read to some people like its some magical new flexibility, he said. But the agreement is limited to taking the most awkward way to do exports and making it less awkward, he said.

Fridays agreement clarifies and expands existing mechanisms allowing for compulsory licensing, in which governments override intellectual property restrictions to allow manufacture of medications, typically in emergency situations. But compulsory licensing has not been easy in the past.

Its just politically really, really difficult, and the countries that do try to do it are faced with a lot of pressure, said Melissa Barber, a researcher who studies access to medicines at the Harvard T.H. Chan School of Public Health. Maybe this will make it easier, but I think those power dynamics arent going to change.

See more here:

W.T.O. Agrees to Limited Relaxing of Patent Protections on Covid Vaccines - The New York Times